PREVALENCE AND RISK FACTORS OF MULTIDRUG-RESISTANT BACTERIAL INFECTIONS AMONG PALESTINIAN ONCOLOGICAL PATIENTS: AN EPIDEMIOLOGICAL RETROSPECTIVE STUDY

Abstract

Abstract

Background and Objectives Multidrug-resistant organisms (MDROs) infections pose a major threat to hospitalized immunocompromised patients, frequent healthcare exposures, and heavy broad-spectrum antibiotic usage among cancer patients makes them highly vulnerable. In Palestinian tertiary healthcare settings, rising antimicrobial resistance increasingly compromises empiric therapy and drives adverse outcomes. This study evaluated MDRO epidemiology, antimicrobial susceptibility profiles, empiric treatment concordance, and independent risk factors for mortality and treatment escalation among cancer patients. Methods A retrospective multicentred study analysed 11,357 positive bacterial cultures collected between 2022 and 2023 across two tertiary facilities to establish isolate-level MDRO prevalence. Detailed clinical, microbiological, and therapeutic data were abstracted for 402 cancer patients with laboratory-confirmed MDRO infections. Univariate analysis and multivariable logistic regression identified independent predictors of in-hospital mortality and treatment escalation (p < 0.05). Results MDRO prevalence was significantly elevated in cancer patients compared to non-cancer controls (33.1% vs. 28.0%) ¸ (p < 0.001). Gram-negative pathogens predominated, driven by carbapenem-resistant Enterobacteriaceae (CRE, 37.6%), Pseudomonas aeruginosa (20.6%), and Acinetobacter baumannii (17.7%). Initial empiric coverage demonstrated poor concordance with culture-directed therapy, especially for vancomycin-resistant Enterococci (14.0%) and P. aeruginosa (22.9%). Overall, in-hospital mortality reached 32.3%, septic shock developed in 27.9%, and 62.7% of patients required antimicrobial escalation. Independent predictors of mortality included septic shock (aOR = 8.94), hospital-acquired infection (aOR = 3.49), A. baumannii infection (aOR = 3.09), and central venous catheterization (aOR = 2.80), while recent chemotherapy was protective (aOR = 0.23). Hospital-acquired infection (aOR = 2.92), active neutropenia (aOR = 2.13), and prior antibiotic use (aOR = 1.82) independently predicted treatment escalation. Conclusions Palestinian oncology patients face a heavy burden of MDRO infections characterized by extensive resistance, frequent empiric failure, and high mortality. Enhancing outcomes requires robust infection control, rapid diagnostic technologies, tailored empiric protocols, and active antimicrobial stewardship