Predictors and outcomes of recurrent bloodstream infection in hematological malignancies: a multicenter real-world study.

Recurrent bloodstream infection (RBSI) is a life-threatening complication in patients with hematological malignancies (HMs), yet the determinants of recurrence remain poorly defined. We aimed to characterize the incidence, outcomes, and time-specific predictors of RBSI in HMs, and further explored the prognostic factors of RBSI. We performed a real-world study involving HM patients with BSI from three academic teaching hospitals during January 2010 to August 2023. Clinical characteristics associated with RBSI were assessed at the initial BSI and during subsequent febrile episodes after apparent resolution of the initial infection. Among 1,153 patients with HMs and BSI, 173 (15.0%) developed RBSI, whose mortality increased progressively with recurrent episodes, from 10.7% to 19.0% after the first recurrence, and to 30.5% after the second recurrence (P<0.01). At the initial BSI, a Charlson Comorbidity Index (CCI) >3 was associated with subsequent recurrence. During later febrile episodes, CCI >3, prior antibiotic exposure, acute respiratory failure, and platelet count <10×109/L were enriched in patients with RBSI (all P<0.05). These findings support CCI >3 at initial BSI and adverse clinical features during subsequent fever may facilitate early identification of patients at high risk of recurrence and support more timely, targeted management.