Electronic health record study links prior antimicrobial resistance to bacteraemia in cancer patients
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Key Takeaway
Note prior antimicrobial resistance strongly associates with bacteraemia in cancer patients.
This electronic health record study examined 2752 adults with recent or past cancer diagnostic codes in Oxfordshire, UK. The investigation ran between 1-April-2015 and 31-March-2025. It assessed 22 potential risk-factors including prior antimicrobial susceptibility test results, prior antibiotic exposure, age, and cancer type.
Prior resistance to the same antibiotic in any culture in the last year was strongly associated with antimicrobial resistance across all pathogen-antimicrobial combinations (all p<=0.001). Lymphoid and haematopoietic malignancies were associated with higher odds of trimethoprim-sulfamethoxazole-resistant Enterobacterales compared to colorectal cancer (aOR=2.07; 95%CI 1.40-3.06).
Vancomycin-resistant Enterococcus bacteraemia showed higher odds in lymphoid and haematopoietic malignancies versus colorectal cancer (aOR=6.68; 95%CI 1.21-36.91). Prior antibiotic exposure was positively associated with antimicrobial resistance in four pathogen-antimicrobial combinations, while younger age was positively associated in five combinations. Adverse events were not reported.
The authors noted associations identified without explicitly claiming causality. Prior resistance was identified as the greatest risk factor. Practice relevance was not reported. Clinicians should interpret these findings as observational associations requiring further validation before applying to clinical decision-making.
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View Original Abstract ↓
Objectives: To identifiy risk factors for antimicrobial resistance (AMR) in seven pathogen-antimicrobial combinations in patients with cancer and cancer survivors. Methods: Using data from patients with recent or past cancer diagnostic codes in Oxfordshire, UK, we examined associations between 22 potential risk-factors and AMR in blood culture isolates, collected between 1-April-2015 and 31-March-2025. Results: Among 5,975 bacteraemias in 4,365 adults, we analysed 3,141 (52.6%) due to Enterobacterales and 620 (10.4%) due to Enterococcus faecalis/faecium in 2,752 patients. Fourteen risk-factors for antimicrobial-resistant bacteraemia were identified, varying across pathogen-antimicrobial combinations. Compared with no previous antimicrobial susceptibility test result, prior resistance to the same antibiotic in any culture in the last year was strongly associated with AMR across all pathogen-antimicrobial combinations (all p<=0.001). Prior antibiotic exposure and younger age were also positively associated with AMR in four and five combinations, respectively. Cancer type showed modest effects; lymphoid/haematopoietic malignancies were associated with higher odds (vs colorectal cancer) of trimethoprim-sulfamethoxazole-resistant Enterobacterales (aOR=2.07 95%CI 1.40-3.06) and vancomycin-resistant Enterococcus bacteraemia (aOR=6.68, 1.21-36.91). Conclusions: Previous resistance was the greatest risk factor for bacteraemia with AMR in cancer patients and survivors, with prior antibiotic exposure and age also contributing. Lymphoid/haematopoietic malignancies increased risk of resistance to specific antimicrobials. Keywords: antimicrobial resistance, bacteraemia, cancer, risk factors
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