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Kitaya S, Kakuta R, Kanamori H, Ohkoshi A, Ishii R, Nomura K, Tokuda K, Katori Y. Clinical and Epidemiological Characteristics of Bloodstream Infections in Head and Neck Cancer Patients: A Decadal Observational Study. J Clin Med 2022; 11:jcm11164820. [PMID: 36013061 PMCID: PMC9409783 DOI: 10.3390/jcm11164820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
This retrospective study aims to describe the clinico-epidemiological characteristics of bloodstream infections (BSIs) and the risk factors in patients with head and neck cancer (n = 227) treated at the Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital between April 2011 and March 2021. Overall, 23.3% of blood cultures were positive. In the culture-positive group, catheter-related bloodstream infections (CRBSIs) were the most common (38.8%), followed by respiratory tract infections (19.4%), and catheter-associated urinary tract infections (6.0%). Methicillin-resistant Staphylococcus aureus (26.9%), Staphylococcus epidermidis (17.9%), and Pseudomonas aeruginosa (10.4%) infections were common. The most frequent treatment for head and neck cancer was surgery (23.9%), followed by treatment interval or palliative care (19.4%), and single radiotherapy (13.4%). The 30-day mortality rate was significantly higher in the BSI than in the non-BSI group (10.4% vs. 1.8%, respectively). CRBSIs are the most frequent source of BSIs in patients with head and neck cancer. In conclusion, central venous catheters or port insertion should be used for a short period to prevent CRBSIs. The risk of developing BSI should be considered in patients with pneumonia. Understanding the epidemiology of BSIs is crucial for diagnosing, preventing, and controlling infections in patients with head and neck cancer.
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Affiliation(s)
- Shiori Kitaya
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
- Correspondence: ; Tel.: +81-022-7177304
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Ryo Ishii
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Koichi Tokuda
- Department of Infectious Diseases, Internal Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
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Clinical Analysis of Bloodstream Infection of Escherichia coli in Patients with Pancreatic Cancer from 2011 to 2019. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:1338188. [PMID: 35340919 PMCID: PMC8942694 DOI: 10.1155/2022/1338188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022]
Abstract
Background Pancreatic cancer patients were particularly predisposed to develop Escherichia coli (E. coli) bloodstream infection (BSI); however, little information is currently available. We set out to find E. coli BSI's risk factors in pancreatic cancer to provide valuable experience. Methods We retrospectively analyzed the clinical data of pancreatic cancer patients (31 cases with E. coli BSI and 93 cases without BSI) by a case-control study. SPSS 17.0 was adopted to perform univariate and multivariate analyses. Bacterial resistance analysis was performed by Whonet 5.6. Results Hospitalization days ≥7 days, number of admissions ≥2 times, surgery, chemotherapy, the type of antibiotics used ≥2 species, albumin<40.0 g/L, and prealbumin < 0.2 g/L were the potential risk factors for pancreatic cancer patients with E. coli BSI (P < 0.1). Multivariate logistic regression showed hospitalization days ≥7 days (OR = 11.196, 95% CI = 0.024–0.333, P < 0.001), surgery (OR = 32.053, 95% CI = 0.007–0.137, P < 0.001), and chemotherapy (OR = 6.174, 95% CI = 0.038–0.688, P=0.014) were the independent risk factors for E. coli BSI of pancreatic cancer patients. E. coli resistant to carbapenems was rare; they were susceptible to cephamycin and piperacillin/tazobactam. The 90-day mortality rate of the infected group was significantly higher than the control group (41.9% versus 8.6%, P < 0.001). Conclusions Hospitalization days ≥7 days, surgery, and chemotherapy are the independent risk factors for E. coli BSI of pancreatic cancer patients, which allows us to identify patients at potential risk and perform preventive treatment in time.
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Facchin G, Candoni A, Lazzarotto D, Zannier ME, Peghin M, Sozio E, Pellegrini N, Filì C, Sartor A, Tascini C, Fanin R. Clinical characteristics and outcome of 125 polymicrobial bloodstream infections in hematological patients: an 11-year epidemiologic survey. Support Care Cancer 2021; 30:2359-2366. [PMID: 34741656 DOI: 10.1007/s00520-021-06640-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Polymicrobial bloodstream infections (pBSI) occurring in hematological patients are still poorly understood, and specific information are very limited. OBJECTIVES AND METHODS In this epidemiologic survey, we describe clinical characteristics and outcome of 125 consecutive pBSI occurred in oncohematological patients. Polymicrobial bloodstream infections (pBSI) were defined with the isolation of 2 or more bacteria from blood culture specimens obtained within 72 h. RESULTS Over an 11-year period, we documented 500 bacterial bloodstream infections (BSI) in 4542 hospital admissions and 25% (125) of these were pBSI. Most common underlying hematological disease was acute myeloid leukemia and 89% of patients had severe neutropenia. Fifty pBSI (40%) occurred in patients undergoing a stem cell transplantation (SCT), mostly within 30 days from transplant (42/50-84%). Principal bacterial association was Gram-positive plus Gram-negative (57%). Resolution rate of pBSI was 82%, without differences between SCT and non-SCT cases. pBSI-related mortality was 15% (6% in SCT cases). Septic shock occurred in 16% of cases and septic shock-related mortality was 65% (75% in SCT cases and 63% in non-SCT cases; p = 0.6). Multidrug-resistant (MDR) bacteria were involved in 22% of pBSI and the MDR-pBSI-related mortality was significantly higher in SCT patients (p = 0.007). CONCLUSIONS This observational study highlights that pBSI is not a rare bloodstream infectious complication in oncohematological patients. pBSI-related mortality is lower than 20%, but, if septic shock occurs, mortality reaches 65%. MDR bacteria were involved in 22% of cases and pBSI-MDR-related mortality was significantly higher in SCT patients.
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Affiliation(s)
- Gabriele Facchin
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.
| | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Davide Lazzarotto
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Maria Elena Zannier
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Maddalena Peghin
- Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Emanuela Sozio
- Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Nicolò Pellegrini
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Carla Filì
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Assunta Sartor
- Clinical Microbiology, University Hospital ASUFC, Udine, Italy
| | - Carlo Tascini
- Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
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Åttman E, Syrjänen J, Lyytikäinen O, Ollgren J, Sinisalo M, Vuento R, Mattila E, Huttunen R. Healthcare-associated blood stream infections in hematological patients in Finland during the years 2006-2016. Eur J Haematol 2021; 107:311-317. [PMID: 33987847 DOI: 10.1111/ejh.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim was to identify the clinical characteristics, outcome, and antimicrobial susceptibility of healthcare-associated bloodstream infections (BSIs) in hematological patients. METHODS This retrospectively collected laboratory-based surveillance data include 3404 healthcare-associated BSIs in 2296 patients with a hematological malignancy in hospitals participating in the Finnish Hospital Infection Program from January 1, 2006, to December 31, 2016. RESULTS The most common underlying diseases were acute myelogenous leukemia (35%) and non-Hodgkin lymphoma (22%). Gram-positive organisms accounted for 60%-46% and gram-negative organisms for 24%-36% of BSIs in 2006-2016. The most common causative organism was coagulase-negative staphylococci (CoNS) (n = 731). The 7- and 28-day case fatality rates were 5.2% and 11.4%, respectively, and was highest in BSIs caused by Candida species (10.8% and 30.8%). The median age of patients increased from 59 years in 2006-2008 to 62 years in 2015-2016 (P < .01). Five percent of S aureus isolates were resistant to methicillin and five percent of Pseudomonas aeruginosa isolates were multidrug-resistant. Four percent of Klebsiella and seven percent of E coli isolates were resistant to ceftazidime. CONCLUSIONS The proportion of gram-positive bacteria decreased and gram-negative bacteria increased over time. The case fatality rate was low and the median age of patients increased during the study.
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Affiliation(s)
- Emilia Åttman
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Outi Lyytikäinen
- Department of Infectious Disease Epidemiology, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Department of Infectious Disease Epidemiology, National Institute for Health and Welfare, Helsinki, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | | | - Erja Mattila
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Chen S, Liu S, Yuan X, Wang H, Wen F. Evaluation of Inflammatory Biomarkers in Pediatric Hematology-Oncology Patients With Bloodstream Infection. J Pediatr Hematol Oncol 2021; 43:e596-e600. [PMID: 32941295 DOI: 10.1097/mph.0000000000001935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
Bloodstream infection (BSI) is a serious complication in pediatric hematology-oncology patients. To evaluate the clinical significance of C-reactive protein (CRP), procalcitonin (PCT), albumin, fibrinogen, and D-dimer as potential biomarkers to differentiate among various subtypes of BSIs in pediatric patients with hematologic and oncologic diseases, we retrieved and analyzed the medical records of pediatric hematology-oncology patients diagnosed with BSI at our hospital between January 2016 and December 2017. The demographic (sex and age) and clinical (primary diseases) characteristics, and laboratory test results (white blood cell and absolute neutrophil counts, and serum CRP, PCT, albumin, fibrinogen, and D-dimer levels) were compared between nosocomial and non-nosocomial; neutropenic and non-neutropenic; and Gram-positive and Gram-negative BSI episodes. A total of 125 BSI episodes were included, including 69 (55.2%) nosocomial cases, 94 (75.2%) neutropenic cases, and 49 (39.2%) Gram-positive episodes. Of the 5 potential biomarkers evaluated (CRP, PCT, albumin, fibrinogen, and D-dimer), PCT levels were significantly lower in neutropenic episodes and Gram-positive BSIs (P=0.008 and P=0.001, respectively). At a cutoff value of 0.67 ng/mL, the diagnostic sensitivity, specificity, and positive/negative predictive values of PCT for the differentiation of Gram-positive and Gram-negative bacterial sepsis were 74.2%, 64.6%, 70.8%, and 65.2%, respectively. We concluded that PCT might potentially serve as a biomarker to differentiate between Gram-positive and Gram-negative BSIs in pediatric hematology-oncology patients.
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Affiliation(s)
- Senmin Chen
- Hematology and Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
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Van de Louw A, Rello J, Martin-Loeches I, Mokart D, Metaxa V, Benoit D, Barratt-Due A, Soares M, Pickkers P, Antonelli M, Demoule A, Schellongowski P, Kouatchet A, Mehta S, Balik M, Bauer PR, Lemiale V, Walter V, Azoulay E. Bacteremia in critically ill immunocompromised patients with acute hypoxic respiratory failure: A post-hoc analysis of a prospective multicenter multinational cohort. J Crit Care 2021; 64:114-119. [PMID: 33872917 DOI: 10.1016/j.jcrc.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The characteristics and impact of bacteremia have not been widely investigated in immunocompromised patients with acute respiratory failure (ARF). METHODS We performed a secondary analysis of a prospective cohort of immunocompromised patients with ARF (EFRAIM study). After exclusion of blood cultures positive for coagulase negative Staphylococci, we compared patients with (n = 236) and without (n = 1127) bacteremia. RESULTS The incidence of bacteremia was 17%. Bacterial pneumonia and extra-pulmonary ARDS were the main causes of ARF in bacteremic patients. Bacteremia involved gram negative rods (48%), gram positive cocci (40%) or were polymicrobial (10%). Bacteremic patients had more hematological malignancy, higher SOFA scores and increased organ support within 7 days. Bacteremia was associated with higher crude ICU mortality (40% versus 32%, p = 0.02), but neither hospital (49% versus 44%, p = 0.17) nor 90-day mortality (60% versus 56%, p = 0.25) were different from non-bacteremic patients. After propensity score matching based on baseline characteristics, the difference in ICU mortality lost statistical significance (p = 0.06), including in a sensitivity analysis restricted to patients with pneumonia. CONCLUSIONS We analyzed a large population of immunocompromised patients with ARF and an incidence of bacteremia of 17%. We could not demonstrate an impact of bacteremia on mortality after adjusting for baseline characteristics.
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Affiliation(s)
- Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA.
| | - Jordi Rello
- Centro de Investigación Biomédica en Red en enfermedades respiratorias (Ciberes), Instituto Salud Carlos III, Barcelona, Spain; Infectious Area, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland; Department of Respiratory Medicine, Hospital Clinic, IDIBAPS, CIBERes, Barcelona, Spain; Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland
| | - Djamel Mokart
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital, NHS Foundation Trust, London SE5 9RS, UK
| | - Dominique Benoit
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Andreas Barratt-Due
- Department of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduação em Clínica Médica, Rio De Janeiro, Brazil
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Massimo Antonelli
- Department of Anesthesia, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alexandre Demoule
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | | | - Achille Kouatchet
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginie Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Vonn Walter
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
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Tolnai E, Fidler G, Szász R, Rejtő L, Nwozor KO, Biró S, Paholcsek M. Free circulating mircoRNAs support the diagnosis of invasive aspergillosis in patients with hematologic malignancies and neutropenia. Sci Rep 2020; 10:16532. [PMID: 33020578 PMCID: PMC7536194 DOI: 10.1038/s41598-020-73556-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
Fungal infections represent a worrisome complication in hematologic cancer patients and in the absence of disease specific symptoms, it is important to establish new biological indicators, which can be used during mould-active prophylaxis. Recently, miRNAs have appeared as candidate diagnostic and prognostic markers of several diseases. A pilot clinical study was performed to evaluate the diagnostic utility of 14 microRNAs which can be related to invasive fungal infections. Based on our data miR-142-3p, miR-142-5p, miR-26b-5p and miR-21-5p showed significant overexpression (p < 0.005) due to invasive aspergillosis in hemato-oncology patients with profound neutropenia. A tetramiR assay was designed to monitor peripheral blood specimens. Optimal cut-off was estimated by using the median value (fold change 1.1) of the log10 transformed gene expressions. The biomarker panel was evaluated on two independent sample cohorts implementing different antimicrobial prophylactic strategies. The receiver operating characteristic analysis with area under the curve proved to be 0.97. Three miRNAs (miR-142-5p, miR-142-3p, miR-16-5p) showed significant expression alterations in episodes with sepsis. In summary, the tetramiR assay proved to be a promising diagnostic adjunct with sufficient accuracy and sensitivity to trace invasive aspergillosis in hemato-oncology patients.
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Affiliation(s)
- Emese Tolnai
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Gábor Fidler
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Róbert Szász
- Division of Haematology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Rejtő
- Department of Hematology, Jósa András Teaching Hospital, Nyíregyháza, Hungary
| | - Kingsley Okechukwu Nwozor
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Sándor Biró
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Melinda Paholcsek
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary.
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Microbiologically Documented Bloodstream Infection in Children With Malignancies: A Single-center Experience. J Pediatr Hematol Oncol 2020; 42:e558-e562. [PMID: 32097279 DOI: 10.1097/mph.0000000000001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bloodstream infection (BSI) remains a considerable cause of morbidity and mortality for cancer patients. With a better understanding of it, better methods can be used. The primary objective of this study was to describe the characteristics of BSIs in our institution, and the second was to determine the possible risk factors associated with them. MATERIALS AND METHODS Data of cancer patients from 2009 to 2015 at our institution were included. Medical information and blood cultures were analyzed to determine the BSI rate. The χ and Fisher exact tests were used for categorical data and to determine risk factors associated with BSIs and pathogens. RESULTS A total of 565 (8.6%) events were diagnosed with BSIs. Although Gram-negative bacteria (52.6%) were the most commonly isolated pathogens, Gram-positive microorganisms (45.0%) were also prevalent. Oral and gastrointestinal organisms were common. Pathogens were more likely to be identified in patients with central venous catheters and in patients with prolonged neutropenia (P<0.05). CONCLUSIONS This study provides updated epidemiology in BSIs and helps with the prevention and management of suspected BSIs in vulnerable patients. Better anti-infection therapy could be provided to these patients based on the isolated pathogens.
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An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality. Ann Hematol 2020; 99:1925-1932. [PMID: 32564194 DOI: 10.1007/s00277-020-04144-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/14/2020] [Indexed: 02/03/2023]
Abstract
Antimicrobial stewardship is of major importance in patients with febrile neutropenia (FN). In this study, we aimed to investigate the trends in resistance and the relationship with mortality rates in patients with FN. The single-center surveillance data of inpatients with FN and diagnosed as microbiologically confirmed bloodstream infections (BSIs) between 2006 and 2016 were reviewed retrospectively. A total of 950 episodes in 552 patients with BSIs were analyzed. Of whom, 55.9% were male, the median age was 43 years, and 35.6% had acute myeloid leukemia. In total, 1016 microorganisms were isolated from blood cultures. Gram-negatives accounted for 42.4% (n = 403) of the episodes. Among Gram-negatives, Enterobacteriaceae accounted for 346 (86%) (E. coli, n = 197; 34% extended-spectrum β-lactamases (ESBL) producers, and Klebsiella spp., n = 120; 48.3% ESBL producers). Also, 24 (20.0%) of Klebsiella spp. had carbapenemase activity. There were 6 (5.0%) colistin-resistant Klebsiella spp. Thirteen (26.5%) of Pseudomonas spp. and 17 (60.7%) of Acinetobacter spp. had carbapenemase activity. There were 2 (5.6%) colistin-resistant Acinetobacter spp. The 30-day mortality rates were 12.0%, 21.5%, 34.6%, and 29.0% in BSIs due to Gram-positive, Gram-negative bacterial, fungal, and polymicrobial etiology respectively (p = 0.001). BSIs with ESBL-producing (p = 0.001) isolates, carbapenem (p < 0.001), and colistin-resistant isolates (p < 0.001) were associated with increased mortality risk. The tremendous rise in resistance rates among Gram-negatives is dreadfully related to increasing mortality and leads to sharp shifts toward extreme restrictions of unnecessary antibiotic uses. Antimicrobial stewardship in patients with FN requires vigilance and tailoring of treatment upon local surveillance data.
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Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review. Int J Infect Dis 2020; 92:89-96. [PMID: 31926353 DOI: 10.1016/j.ijid.2020.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Pasteurella bacteraemia is rare, but has been associated with a high mortality rate. The aim of this study was to estimate the impact of comorbidities on patients with Pasteurella bacteraemia. METHODS All cases of Pasteurella bacteraemia in adults treated in our centre between January 2008 and December 2017 were included retrospectively and compared with cases identified in a systematic review of the literature via MEDLINE covering the years 1951-2017. The epidemiological, bacteriological, and clinical data were collected, as well as the instances of death after 30 days. RESULTS Twenty cases of Pasteurella bacteraemia identified in our centre and 99 cases from the literature review were included. A major comorbidity was found in 80/119 (67.2%) patients. The death rate at 30 days was 31.1%. The most common comorbidities were cirrhosis, immunosuppressive therapy, and malignant diseases. Age was not associated with mortality. On multivariate analysis, the only factor associated with mortality was a major comorbidity (odds ratio 2.78, 95% confidence interval 1.01-7.70; p = 0.04). CONCLUSIONS This study confirms the high mortality rate and highlights the importance of the host background, independent of age, in Pasteurella bacteraemia. Clinicians should be aware of the comorbidities in cases of Pasteurella infection, due to the poor prognosis of bacteraemia.
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Chen S, Liu S, Yuan X, Mai H, Lin J, Wen F. Etiology, drug sensitivity profiles and clinical outcome of bloodstream infections: A retrospective study of 784 pediatric patients with hematological and neoplastic diseases. Pediatr Hematol Oncol 2019; 36:482-493. [PMID: 31718370 DOI: 10.1080/08880018.2019.1667462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bloodstream infections (BSI) represent one of the most serious complications in patients in the hematology-oncology unit. In this study, the prevalence, distribution, drug sensitivity profiles, and clinical outcome of BSI were analyzed in pediatric patients with hematological malignancies. Patients admitted to the pediatric hematology-oncology unit at Shenzhen Children's Hospital (Shenzen, China) between January 2016 and December 2017 were enrolled. Their medical records, including gender, age, primary diseases, and microbiology results of all clinical specimens, were reviewed. The incidence of BSI, microbiology characteristics, and effectiveness of antimicrobial therapy were analyzed. A total of 125 BSI cases in 108 patients (mean age, 5.5 years) were recorded, of which 69 (55.2%) were nosocomial BSI cases. The overall rate of BSI was 18.8% in the hematology-oncology unit, of which 75 (75.2%) episodes were neutropenic patients. Patients with nosocomial BSIs and the neutropenic group were older (p#.02, p#.03). HSCTs and AML were more often observed in nosocomial BSIs, while solid tumors were more found in nonnosocomial and non-neutropenic BSIs. BSIs were dominated by Gram-negative pathogens (49.6%) in the hematology-oncology unit compared with Gram-positive pathogens (39.2%). The most common pathogens were coagulase-negative Staphylococcus (24.2%) followed by Klebsiella pneumonia (15.2%), Escherichia coli (12.5%), viridans streptococci (8.2%), and Candida species (7.8%). The antibiotic therapy success rate in patients was 93.5%. Based on our center's experience, Gram-negative pathogens were commonly observed among pediatric hematology-oncology patients with BSI. Coagulase-negative Staphylococcus and K. pneumoniae predominated and antibiotic therapy was effective in these patients.
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Affiliation(s)
- Senmin Chen
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Hematology and Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Sixi Liu
- Hematology and Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiuli Yuan
- Hematology and Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Huirong Mai
- Hematology and Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Junrong Lin
- Hematology and Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Feiqiu Wen
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Hematology and Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
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12
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Joncour A, Puyade M, Michaud A, Tourani JM, Cazenave-Roblot F, Rammaert B. Is current initial empirical antibiotherapy appropriate to treat bloodstream infections in short-duration chemo-induced febrile neutropenia? Support Care Cancer 2019; 28:3103-3111. [DOI: 10.1007/s00520-019-05113-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
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13
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Shock and Early Death in Hematologic Patients with Febrile Neutropenia. Antimicrob Agents Chemother 2019; 63:AAC.01250-19. [PMID: 31405857 DOI: 10.1128/aac.01250-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/07/2019] [Indexed: 02/08/2023] Open
Abstract
Empirical antibiotic therapy with a beta-lactam is the standard of care in febrile neutropenia (FN) and is given to prevent early death. The addition of vancomycin is recommended in certain circumstances, but the quality of evidence is low, reflecting the lack of clinical data. In order to characterize the epidemiology of early death and shock in FN, we reviewed all episodes of FN from 2003 to 2017 at University Hospital, Federal University of Rio de Janeiro, and looked at factors associated with shock at first fever and early death (within 3 days from first fever) by univariate and multivariate analyses. Among 1,305 episodes of FN, shock occurred in 42 episodes (3.2%) and early death in 15 (1.1%). Predictors of shock were bacteremia due to Escherichia coli (odds ratio [OR], 8.47; 95% confidence interval [95% CI], 4.08 to 17.55; P < 0.001), Enterobacter sp. (OR, 7.53; 95% CI, 1.60 to 35.33; P = 0.01), and Acinetobacter sp. (OR, 6.95; 95% CI, 1.49 to 32.36; P = 0.01). Factors associated with early death were non-Hodgkin's lymphoma (OR, 3.57; 95% CI, 1.18 to 10.73; P = 0.02), pneumonia (OR, 21.36; 95% CI, 5.72 to 79.72; P < 0.001), shock (OR, 11.64: 95% CI, 2.77 to 48.86; P = 0.01), and bacteremia due to Klebsiella pneumoniae (OR, 5.91; 95% CI, 1.11 to 31.47; P = 0.03). Adequate empirical antibiotic therapy was protective (OR, 0.23; 95% CI, 0.07 to 0.81; P = 0.02). Shock or early death was not associated with Gram-positive bacteremia; catheter-related, skin, or soft tissue infection; or inadequate Gram-positive coverage. These data challenge guideline recommendations for the empirical use of vancomycin at first fever in neutropenic patients.
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Delebarre M, Dessein R, Lagrée M, Mazingue F, Sudour-Bonnange H, Martinot A, Dubos F. Differential risk of severe infection in febrile neutropenia among children with blood cancer or solid tumor. J Infect 2019; 79:95-100. [PMID: 31228471 DOI: 10.1016/j.jinf.2019.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe and analyze the differences between infections in children with febrile neutropenia (FN) treated for solid tumor or blood cancer. METHODS A prospective study included all episodes of FN in children from April 2007 to April 2016 in 2-pediatric cancer centers in France. Medical history, clinical and laboratory data available at admission and final microbiological data were collected. The proportion of FN, severe infection, categories of microorganisms and outcomes were compared between the two groups. The presumed gateway of the infection was a posteriori considered and evaluated. RESULTS We analyzed 1197 FN episodes (mean age: 8 years). 66% of the FN episodes occurred in children with blood cancer. Severe infections were identified in 23.4% of episodes overall. The rate of severe infection (28.4% vs. 10.4%), types of microorganisms and the need for a management in intensive care unit (2.6% vs. 0.5%) was significantly different between children with blood cancer and solid tumor. Digestive or respiratory presumed gateway of the infections was less frequent for patients with solid tumor. CONCLUSION Given these important microbiological and clinical differences, it may be appropriate to consider differently the risk of severe infection in these two populations and therefore the management of FN.
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Affiliation(s)
- Mathilde Delebarre
- Univ. Lille, CHU Lille, 2 avenue Oscar Lambret, F-59000 Lille, France; EA2694, Public Health, Epidemiology and Quality of Care, F-59000 Lille, France; CHU Lille, Pediatric Emergency Unit & Infectious Diseases, F-59000 Lille, France
| | - Rodrigue Dessein
- Univ. Lille, CHU Lille, 2 avenue Oscar Lambret, F-59000 Lille, France; CHU Lille, Microbiology Unit, Pathology-Biology Center, F-59000 Lille, France
| | - Marion Lagrée
- CHU Lille, Pediatric Emergency Unit & Infectious Diseases, F-59000 Lille, France
| | | | | | - Alain Martinot
- Univ. Lille, CHU Lille, 2 avenue Oscar Lambret, F-59000 Lille, France; EA2694, Public Health, Epidemiology and Quality of Care, F-59000 Lille, France; CHU Lille, Pediatric Emergency Unit & Infectious Diseases, F-59000 Lille, France
| | - François Dubos
- Univ. Lille, CHU Lille, 2 avenue Oscar Lambret, F-59000 Lille, France; EA2694, Public Health, Epidemiology and Quality of Care, F-59000 Lille, France; CHU Lille, Pediatric Emergency Unit & Infectious Diseases, F-59000 Lille, France.
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15
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Ge J, Yang T, Zhang L, Zhang X, Zhu X, Tang B, Wan X, Tong J, Song K, Yao W, Sun G, Sun Z, Liu H. The incidence, risk factors and outcomes of early bloodstream infection in patients with malignant hematologic disease after unrelated cord blood transplantation: a retrospective study. BMC Infect Dis 2018; 18:654. [PMID: 30545330 PMCID: PMC6293544 DOI: 10.1186/s12879-018-3575-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 11/30/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Bloodstream infection (BSI) is one of the major causes of morbidity and mortality for patients undergoing hematopoietic stem cell transplantation (HSCT). The unrelated cord blood transplantation (UCBT) can provided opportunities for patients without suitable donors for bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT), while few studies have addressed BSI after UCBT. The aim of this study was to analyse the incidence and risk factors of BSI, causative organisms, microbial resistance, and its impact on the clinical outcomes and survival of patients. METHODS There are 336 patients, were divided into two groups depending on whether developing BSI. Demographic characteristics, laboratory data, and clinical outcome were compared between different groups. The risk factors of BSI was examined using logistic regression and the survival was examined using the Kaplan-Meier method and log-rank test. RESULTS Ninety-two patients (27.4%) developed early BSI with 101 pathogenic bacteria isolated, and the median day of developing initial BSI was 4.5 d. Gram-negative bacteria were the most common isolate (60, 59.4%), followed by Gram-positive bacteria (40, 39.6%) and fungi (1, 1.0%). Thirty-seven (36.6%) isolates were documented as having multiple drug resistance (MDR). Myeloid malignancies, conditioning regimens including total body irradiation (TBI), and prolonged neutropenia were identified as the independent risk factors for early BSI. The 3-year OS was 59.9% versus 69.2% in the BSI group and no-BSI group (P = 0.0574), respectively. The 3-year OS of the MDR group was significantly lower than that of the non-BSI group (51.1% versus 69.2%, p = 0.013). CONCLUSIONS Our data indicate that the incidence of early BSI after UCBT was high, especially in patients with myeloid disease and a conditioning regimen including TBI and prolonged neutropenia. Early BSI with MDR after UCBT had a negative impact on long-term survival.
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Affiliation(s)
- Jing Ge
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Tingting Yang
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Lei Zhang
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xuhan Zhang
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xiaoyu Zhu
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Baolin Tang
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xiang Wan
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Juan Tong
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Kaidi Song
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Wen Yao
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Guangyu Sun
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zimin Sun
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Huilan Liu
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, 17 Lujiang Road, Hefei, 230001, Anhui, China. .,Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China.
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16
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Tang SY, Zhang SW, Wu JD, Wu F, Zhang J, Dong JT, Guo P, Zhang DL, Yang JT, Zhang WJ. Comparison of mono- and combination antibiotic therapy for the treatment of Pseudomonas aeruginosa bacteraemia: A cumulative meta-analysis of cohort studies. Exp Ther Med 2018; 15:2418-2428. [PMID: 29456647 PMCID: PMC5795571 DOI: 10.3892/etm.2018.5727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/04/2017] [Indexed: 12/14/2022] Open
Abstract
It is currently unknown whether antibiotic monotherapy or combination therapy is a more effective treatment for patients with Pseudomonas aeruginosa bacteraemia. The present study consists of a systematic review and meta-analysis of cohort studies in associated studies. The treatment options of monotherapy and combination therapy have been compared, to determine which is more effective against P. aeruginosa bacteraemia. Several electronic bibliographic databases were systematically searched and clinical studies that compared combination therapy with monotherapy for P. aeruginosa bacteraemia were identified. Dersimonian and Laird's random-effects models were used to generate summary estimates of the effects and to assess their association according to different patient characteristics and research quality standards. A total of 17 studies were selected, 3 of which were prospective while the remaining 14 were retrospective. The studies involved a total of 2,504 patients. Significant differences between combination therapy and monotherapy treatment were not found when the data were combined (odds ratio (OR)=0.81, 95% confidence interval (CI)=0.61–1.08; P=0.035). The results demonstrated strength in a number of stratification and sensitivity analyses. The variables used included study type, treatment quality score and survival rate of subgroup analysis. To conduct cumulative meta-analysis, the number of years and samples were calculated. The OR value and 95% CI were stable and demonstrated good change trend. According to the size of the sample order following accumulation, OR values and 95% CI (0.89, 0.76–1.04) exhibited a narrow range. Neither combination therapy or monotherapy exhibited significant effects on the mortality of patients with P. aeruginosa bacteraemia. Future research is required and should include large, well-designed prospective cohorts, and grouped clinical studies.
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Affiliation(s)
- Su Yu Tang
- Intensive Care Unit, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Shun Wen Zhang
- Department of First Clinical Medicine, The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 211166, P.R. China
| | - Jiang Dong Wu
- Department of Pathophysiology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Fang Wu
- Department of Pathophysiology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Jie Zhang
- Intensive Care Unit, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Jiang Tao Dong
- Intensive Care Unit, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Peng Guo
- Intensive Care Unit, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Da Long Zhang
- Intensive Care Unit, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Jun Ting Yang
- Department of Pathophysiology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
| | - Wan Jiang Zhang
- Department of Pathophysiology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang 832002, P.R. China
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Al-Otaibi FE, Bukhari EE, Badr M, Alrabiaa AA. Prevalence and risk factors of Gram-negative bacilli causing blood stream infection in patients with malignancy. Saudi Med J 2017; 37:979-84. [PMID: 27570854 PMCID: PMC5039618 DOI: 10.15537/smj.2016.9.14211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the epidemiology, risk factors, and antibiotic resistance of Gram negative bacteria (GNB) in patients with hematologic or solid organ malignancies. Methods: This is a retrospective study of 61 episodes of GNB bacteremia occurring in 56 patients with malignancy admitted to the Oncology Units in King Khalid University Hospital, Riyadh. Kingdom of Saudi Arabia during the period from January 2013 to October 2015. Data were retrieved from the computerized database of the microbiology laboratory and the patient’s medical records. Results: Hematological malignancies accounted for 30 (54%) and solid tumors accounted for 26 (46%). The most common hematological malignancies were leukemia 23 (77%), followed by lymphoma 6 (20%). Among solid tumors, colorectal cancer 9 (34.6) and breast cancer 6 (23%) were the most common. The most predominant pathogen was Escherichia coli (E. coli) (29.5%) followed by Acinetobacter baumannii (A. baumannii) (18%). The extended-spectrum beta-lactamases producers rate of E. coli and Klebsiella pneumonia was (34.6%). Imipenem resistance among Pseudomonas aeruginosa/A. baumannii was high (52.4%). The multi-resistant organisms rate was (43.5%). Risk factors associated with the bacteremia were ICU admission (32.1%), post-surgery (23.2%), and placement of central line (21.4%). The overall 30-day mortality rate of the studied population was high (32.1%). Conclusion: In light of the high resistant rate among the GNB isolated from malignancy patients from our institution, careful selection of antimicrobial treatment based on antimicrobial susceptibility testing is recommended.
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Affiliation(s)
- Fawzia E Al-Otaibi
- Department of Microbiology, King Saud University, King Khalid Hospital, Riyadh, Kingdom of Saudi Arabia. E-mail.
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18
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Kolonen A, Sinisalo M, Huttunen R, Syrjänen J, Aittoniemi J, Huhtala H, Sankelo M, Rintala H, Räty R, Jantunen E, Nousiainen T, Säily M, Kauppila M, Itälä-Remes M, Ollikainen H, Rauhala A, Koistinen P, Elonen E. Bloodstream infections in acute myeloid leukemia patients treated according to the Finnish Leukemia Group AML-2003 protocol - a prospective nationwide study. Infect Dis (Lond) 2017; 49:799-808. [PMID: 28683646 DOI: 10.1080/23744235.2017.1347814] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infections greatly influence the outcome of acute myeloid leukemia (AML) patients receiving intensive treatment. The aim of this study was to establish the incidence, microbial etiology, risk factors and prognosis of bloodstream infections (BSIs) in patients with AML and compare the results with the previous treatment protocol (AML-92). METHODS Registery data were gathered prospectively from 357 patients aged 16-65 years recruited on the AML-2003 treatment protocol between November 2003 and November 2011 during different treatment cycles. RESULTS Blood culture data were available on 977 treatment episodes, in which there were 503 BSIs (51%). The overall incidence rate (IR) for BSIs (per 1000 hospital days) was 16.7. Twenty patients (5.6%) died due to an infection and 16 of them (80%) had a BSI. The most commonly detected microbes (polymicrobial episodes included) in blood cultures were coagulase-negative staphylococci (CoNS, 24.7%), viridans group streptococci (VGS, 19.1%), enterococci (13.9%) and Enterobacteriacae group (25.9%). The etiology of BSIs varied greatly from treatment cycle to cycle. CONCLUSIONS Enterococcal BSIs have increased compared to our previous treatment protocol, and they represent significant pathogens in blood cultures. Infection-related mortality has decreased despite the increase in the IR of BSIs. Enterococci seem to be an increasingly prominent pathogen underlying BSIs in the AML patients, especially during induction therapy (20%).
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Affiliation(s)
- Aarne Kolonen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Marjatta Sinisalo
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Reetta Huttunen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Jaana Syrjänen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | | | - Heini Huhtala
- c Faculty of Social Sciences , University of Tampere , Tampere , Finland
| | - Marja Sankelo
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Hannele Rintala
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Riikka Räty
- d Department of Hematology , Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Finland
| | - Esa Jantunen
- e Department of Internal Medicine, Kuopio University Hospital , Kuopio , Finland
| | - Tapio Nousiainen
- e Department of Internal Medicine, Kuopio University Hospital , Kuopio , Finland
| | - Marjaana Säily
- f Department of Internal Medicine, Oulu University Hospital , Oulu , Finland
| | - Marjut Kauppila
- g Division of Medicine, Turku University Hospital , Turku , Finland.,h Department of Hematology and Stem Cell Transplantation, Turku University Hospital , Turku , Finland
| | - Maija Itälä-Remes
- g Division of Medicine, Turku University Hospital , Turku , Finland.,h Department of Hematology and Stem Cell Transplantation, Turku University Hospital , Turku , Finland
| | - Hanna Ollikainen
- i Department of Hematology, Satakunta Central Hospital , Pori , Finland
| | | | - Pirjo Koistinen
- f Department of Internal Medicine, Oulu University Hospital , Oulu , Finland
| | - Erkki Elonen
- d Department of Hematology , Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Finland
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El-Mahallawy HA, Hassan SS, El-Wakil M, Moneer MM, Shalaby L. Increasing Antimicrobial Resistance Monitored in Surveillance Analysis of Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients. Asian Pac J Cancer Prev 2016; 16:5691-5. [PMID: 26320437 DOI: 10.7314/apjcp.2015.16.14.5691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous surveillance of pattern of blood stream infection is necessary in febrile neutropenia (FN)especially with the recent escalating trend in the management of pediatric cancer patients towards intensified regimens and with the increase in infections caused by resistant organisms limiting the choice of antibiotics. AIM To monitor change in pattern of blood stream infections (BSI) in FN pediatric cancer patients. MATERIALS AND METHODS Surveillance of FN episodes with positive BSI was prospectively monitored and compared to a previous surveillance in the same pediatric oncology unit. RESULTS A total of 232 BSI positive episodes were documented in 192 patients during a 6 months period. The results of recent surveillance analysis showed an increase in intensified regimens of chemotherapy, antimicrobial resistance, fungal infections, and prolonged duration of episodes when compared to previous surveillance, with p value sof <0.001, 0.005, 0.021, and <0.001, respectively. There was an apparent decrease in the crude mortality but this was not statistically significant, to 6% in 2011 from 10 % in 2006. CONCLUSIONS The pattern of BSI at our institution is still inclining towards gram positive organisms but is showing a shift towards more antibiotic resistance and fungal infections.
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Affiliation(s)
- Hadir A El-Mahallawy
- Clinical Pathology Department, National Cancer Institute, Cairo University Cairo, Egypt E-mail :
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20
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Zhang L, Lu HW, Liu HL, Zhu XY, Tang BL, Zheng CC, Yang HZ, Geng LQ, Ding KY, Wang XB, Han YS, Liu X, Wu JS, Zhu WW, Cai XY, Sun ZM. [Pathogens and clinical characteristics of bacterial infection in hematology department between 2010 and 2014]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:383-7. [PMID: 27210872 PMCID: PMC7348313 DOI: 10.3760/cma.j.issn.0253-2727.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyze the characteristics of distribution and drug resistance of bacterial infection in several different parts of hematology department inpatients of Anhui Provincial Hospital from January 2010 to December 2014, including patients who had received hematopoietic stem cell transplantation (HSCT). METHODS Anti-microbial susceptibility test was done by Kirby-Bauer method and automated systems and the data were analysed by WHONET 5.6 software. RESULTS A total of 3 312 copies of inspection samples were analyzed, including 2 716 (82%) blood samples and other 596 specimens (18%). 634 bacterial strains were isolated from 3 312 samples (19.14%) including 488 samples (76.97%) from blood culture. 427 (67.35%) bacterial strains were gram-negative, and the other 207 (32.65%) were gram-positive. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were most common gram-negative bacterial and the resistant rates to imipenem were 0.8%, 11.8% and 3.3%, respectively. Detection rates of Extended-spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae were 83.9% and 75.0%, respectively. At the same time, Coagulase negative Staphylococcus, Streptococcus and Enterococcus were most common kinds of gram-positive bacteria. Methicillin-resistant coagulase negative staphylococcus accounted for 65.9% antibiotic resistance. No vancomycin and/or linezolid and/or tigecycline resistant strains of Staphylococcus spp. and Enterococcus spp. were found in those patients. CONCLUSION Patients with hematology diseases had a higher risk of bacterial infections, mainly caused by Gram-negative bacteria. There are different distributions of bacterial in different wards.
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Affiliation(s)
- L Zhang
- Department of Hematology, Affiliated Provincial Hospital, Anhui Medical University, Hefei 230001, China
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21
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Çalık Başaran N, Karaağaoğlu E, Hasçelik G, Durusu Tanrıöver M, Akova M. Prospective Evaluation of Infection Episodes in Cancer Patients in a Tertiary Care Academic Center: Microbiological Features and Risk Factors for Mortality. Turk J Haematol 2016; 33:311-319. [PMID: 27095391 PMCID: PMC5204186 DOI: 10.4274/tjh.2015.0216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE We aimed to determine the frequency, type, and etiology of infections and the risk factors for infections and mortality in hospitalized cancer patients. MATERIALS AND METHODS We prospectively enrolled adult cancer patients hospitalized in the internal medicine wards of a tertiary care academic center between January and August 2004. Patients were followed during their hospitalization periods for neutropenia, infections, culture results, and mortality. RESULTS We followed 473 cancer patients with 818 hospitalization episodes and 384 infection episodes in total. Seventy-nine percent of the infections were nosocomial, and febrile neutropenia (FN) was observed in 196 (51%) of the infection episodes. Bacteremia was found in 29% of FN episodes and in 8% of nonneutropenic patients. Gram-positive bacteria were the leading cause of bacteremia in both neutropenic and nonneutropenic cases (70% and 58%, respectively). Presence of an indwelling central catheter increased bacteremia risk by 3-fold. The overall mortality rate was 17%, whereas 34% of the patients with bloodstream infections died. Presence of bacteremia and advanced disease stage increased overall mortality by 6.1-fold and 3.7-fold, respectively. CONCLUSION Nearly half of the cancer patients developed an infection during their hospital stays, with gram-positive bacteria being the predominant etiologic microorganisms. This demonstrates the changing trends in infections considering that, until 2004, gram-negative bacteria were the most predominant microorganisms among cancer patients in our institute.
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Affiliation(s)
- Nursel Çalık Başaran
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey, Phone: +90 312 305 30 29, E-mail:
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Gustinetti G, Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence 2016; 7:280-97. [PMID: 27002635 PMCID: PMC4871679 DOI: 10.1080/21505594.2016.1156821] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 12/29/2022] Open
Abstract
Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel de-escalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.
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Affiliation(s)
- Giulia Gustinetti
- Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST, Genova, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST, Genova, Italy
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Zhou SJ, Wang SQ, Ma YY, Tang LY, Shi YF, Liang B, Chen Y, Yu K. Association of proton pump inhibitors with the occurrence of gut-derived bacteraemia in patients with haematological malignancy after chemotherapy. ACTA ACUST UNITED AC 2016; 21:332-7. [PMID: 27077765 DOI: 10.1080/10245332.2016.1142711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gut-derived bacteraemia is a major complication in patients with haematological malignancy after chemotherapy. OBJECTIVE Our study aimed to investigate the role of proton pump inhibitors (PPIs) in the occurrence of gut-derived bacteraemia. METHODS We compared data from 92 hospitalized haematological malignancy patients after chemotherapy with gut-derived bacteraemia, collected from January 2009 to July 2015, with those of 92 contemporaneous, hospitalized haematological malignancy patients without bacteraemia. We evaluated PPIs use and analysed the effects of covariates. RESULTS Patients with gut-derived bacteraemia had a significantly higher incidence of PPIs use (69.6%) than that of controls (47.8%). Of the patients with gut-derived bacteraemia, only 44.6% had a documented indication for PPIs therapy. The antibacterial prophylaxis rate was 38.0% in the bacteraemia group and 58.7% in the non-antibacterial group. Based on multivariable logistic regression analysis, only PPIs use (P = 0.00, odds ratio (OR) = 0.546) was found to be associated with the risk of bacteraemia whereas antibacterial prophylaxis (P = 0.00, OR = 0.652) was protective. There were no significant differences in demographics, malignancy status, length of neutropenia, complications, or steroid use between the gut-derived bacteraemia and control group. CONCLUSIONS This study suggests a potential association between PPIs use and development of gut-derived bacteraemia in haematological malignancy patients after chemotherapy.
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Affiliation(s)
- Shu-Juan Zhou
- a Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Zhejiang 325000 , P.R. China
| | - Si-Qian Wang
- b Department of Prosthodontics, School & Hospital of Stomatology , Wenzhou Medical University , Zhejiang 325000 , P.R. China
| | - Yong-Yong Ma
- a Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Zhejiang 325000 , P.R. China
| | - Li-Yuan Tang
- a Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Zhejiang 325000 , P.R. China
| | - Yi-Fen Shi
- a Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Zhejiang 325000 , P.R. China
| | - Bin Liang
- a Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Zhejiang 325000 , P.R. China
| | - Yi Chen
- a Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Zhejiang 325000 , P.R. China
| | - Kang Yu
- a Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Zhejiang 325000 , P.R. China
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Abstract
Little information is currently available regarding bloodstream infection (BSI) in patients with solid tumors who, for a variety of reasons, are particularly predisposed to develop this condition. In this review we focus on the incidence, epidemiology, clinical features, etiology, antimicrobial resistance, and outcomes of BSI of adult cancer patients with solid tumors. Most episodes of BSI occur in non-neutropenic patients, in whom the site of primary or metastatic tumor often serves as the portal of entry. The urinary tract and the abdomen are the most frequent sources of infection, and cholangitis is the most common recurrent source of BSI. Gram-negative bacilli are becoming the leading cause of BSI in patients with solid tumors, and the rate of multidrug resistance is increasingly being recognized. The case-fatality rate in patients with solid tumors and BSI is high, especially among those with comorbidities, advanced neoplasms, corticosteroid therapy, and shock at presentation.
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Affiliation(s)
- Carlota Gudiol
- a Department of Infectious Diseases , Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,b REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III , Madrid , Spain.,c Institut Català d'Oncologia , Barcelona , Spain
| | - José María Aguado
- b REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III , Madrid , Spain.,d Unit of Infectious Diseases, Instituto de Investigación Hospital, Complutense University , Madrid , Spain
| | - Jordi Carratalà
- a Department of Infectious Diseases , Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,b REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III , Madrid , Spain
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25
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Blennow O, Ljungman P. The challenge of antibiotic resistance in haematology patients. Br J Haematol 2015; 172:497-511. [PMID: 26492511 DOI: 10.1111/bjh.13816] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Bacterial infections were once a major obstacle to the treatment of acute leukaemia. Improvement in management strategies, including the use of broad-spectrum antibacterial drugs targeting Gram-negative bacteria, has reduced the mortality in neutropenic patients developing blood stream infections and other severe infections. In many countries these achievements are threatened by development of multi-resistant bacteria, such as Klebsiella pneumoniae, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. This review addresses the epidemiology, clinical importance and possible management of these multi-resistant organisms.
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Affiliation(s)
- Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Haematology and Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
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Current epidemiology and antimicrobial resistance data for bacterial bloodstream infections in patients with hematologic malignancies: an Italian multicentre prospective survey. Clin Microbiol Infect 2015; 21:337-43. [DOI: 10.1016/j.cmi.2014.11.022] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/16/2014] [Accepted: 11/20/2014] [Indexed: 11/19/2022]
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Marín M, Gudiol C, Ardanuy C, Garcia-Vidal C, Jimenez L, Domingo-Domenech E, Pérez FJ, Carratalà J. Factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection. Clin Microbiol Infect 2015; 21:583-90. [PMID: 25680311 DOI: 10.1016/j.cmi.2015.01.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/09/2015] [Accepted: 01/30/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to identify factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection (BSI). All episodes of BSI occurring in adult neutropenic patients with haematologic malignancies or solid tumours were prospectively recorded from January 2006 to December 2013. We analysed the factors influencing mortality in both groups of patients. We documented 602 consecutive episodes of BSI; 510 occurred in patients with haematologic malignancies and 92 in patients with solid tumours. The overall case-fatality rates were 12% and 36%, respectively. Independent risk factors associated with a higher case-fatality rate in patients with haematologic malignancies were: intensive care unit admission (odds ratio (OR), 15.2; 95% confidence interval (CI), 5.4-42.7), advanced neoplasm (OR, 8.7; 95% CI, 2.9-25.7), corticosteroid therapy (OR, 7.0; 95% CI, 3-16.4), multidrug-resistant Gram-negative BSI (OR, 3.8; 95% CI, 1.2-11.8) and a Multinational Association for Supportive Care in Cancer risk score of <21 (OR, 3.1; 95% CI, 1.3-7.4). By contrast, coagulase-negative staphylococci BSI (OR, 0.04; 95% CI, 0.004-0.5) and empirical antibiotic combination therapy (OR, 0.1; 95% CI, 0.05-0.3) were found to be protective. Independent risk factors for overall case-fatality rate in patients with solid tumours were: shock at presentation (OR, 14.3; 95% CI, 3.2-63.8), corticosteroid therapy (OR, 10; 95% CI, 2.3-44) and advanced neoplasm (OR, 7.8; 95% CI, 1.4-41.4). Prognostic factors identified in this study may help to detect those patients at higher risk of death in each group. Medical intervention addressing some of these factors might improve the outcome of BSI in neutropenic patients with haematologic malignancies or solid tumours.
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Affiliation(s)
- M Marín
- Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain.
| | - C Gudiol
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
| | - C Ardanuy
- Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, Spain
| | - C Garcia-Vidal
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
| | - L Jimenez
- Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - E Domingo-Domenech
- Hematology Department, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain
| | - F J Pérez
- Clinical Research Unit, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain
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El-Mahallawy HA, Hassan SS, El-Wakil M, Moneer MM, Shalaby L. Update on Healthcare-Associated Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jct.2015.66054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bloodstream infections in neutropenic patients with cancer: Differences between patients with haematological malignancies and solid tumours. J Infect 2014; 69:417-23. [DOI: 10.1016/j.jinf.2014.05.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/05/2014] [Accepted: 05/22/2014] [Indexed: 11/23/2022]
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Jamal MA, Rosenblatt J, Jiang Y, Hachem R, Chaftari AM, Raad II. Prevention of transmission of multidrug-resistant organisms during catheter exchange using antimicrobial catheters. Antimicrob Agents Chemother 2014; 58:5291-6. [PMID: 24957841 PMCID: PMC4135861 DOI: 10.1128/aac.02886-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/17/2014] [Indexed: 11/20/2022] Open
Abstract
Exchanging a central venous catheter (CVC) over a guide wire for a fresh uncoated CVC in the presence of bacteremia can result in cross-infection of the newly exchanged CVC. A recent retrospective clinical study showed that exchanging a catheter over a guide wire in the presence of bacteremia using an antimicrobial minocycline-rifampin (M/R) catheter may improve outcomes. To expand on this, we developed an in vitro cross-contamination model of exchange to evaluate the efficacy of different antimicrobial CVCs in preventing cross-contamination of multidrug-resistant organisms during exchange. Uncoated CVCs were allowed to form biofilm by methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans. After 24 h, the biofilm-colonized CVCs were placed in a glass tube containing bovine calf serum plus Mueller-Hinton broth, and each catheter was exchanged over a guide wire for a fresh uncoated or an M/R-, chlorhexidine-silver sulfadiazine (CHX/SS)-, or chlorhexidine-M/R (CHX-M/R)-coated CVC. Cross-contamination of exchanged catheters was enumerated by sonication and quantitative plating methods. The exchange of M/R CVCs completely prevented cross-contamination by MRSA biofilms compared to control exchanged CVCs (P<0.0001). Exchange with CHX/SS CVCs reduced but did not completely prevent cross-contamination by MRSA (P=0.005). Exchange with CHX-M/R CVCs completely prevented cross-contamination by MRSA, P. aeruginosa, and C. albicans biofilms (P<0.0001). Furthermore, CHX-M/R CVCs were superior to M/R CVCs against P. aeruginosa and C. albicans (P=0.003) and were superior to CHX/SS CVCs against MRSA and P. aeruginosa (P=0.01). In conclusion, exchange with the novel CHX-M/R CVC was the only exchange effective in completely and concurrently preventing cross-contamination from bacteria and Candida.
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Affiliation(s)
- Mohamed A Jamal
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ann-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Freire MP, Pierrotti LC, Filho HHC, Ibrahim KY, Magri ASGK, Bonazzi PR, Hajar L, Diz MPE, Pereira J, Hoff PM, Abdala E. Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients. Eur J Clin Microbiol Infect Dis 2014; 34:277-86. [DOI: 10.1007/s10096-014-2233-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
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Characteristics, risk factors and outcomes of adult cancer patients with extensively drug-resistant Pseudomonas aeruginosa infections. Infection 2014; 42:721-8. [DOI: 10.1007/s15010-014-0635-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/10/2014] [Indexed: 02/05/2023]
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Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer. Curr Opin Infect Dis 2014; 27:200-10. [DOI: 10.1097/qco.0000000000000038] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim YJ, Jun YH, Kim YR, Park KG, Park YJ, Kang JY, Kim SI. Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia; retrospective study of impact of combination antimicrobial therapy. BMC Infect Dis 2014; 14:161. [PMID: 24655422 PMCID: PMC3994322 DOI: 10.1186/1471-2334-14-161] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 03/19/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Whether the combination of antimicrobial therapy is a factor in mortality in Pseudomonas aeruginosa bacteremia remains to be elucidated. This study investigated the risk factors for mortality in P. aeruginosa bacteremia patients and the influence of adequate antimicrobial therapy and combination therapy on clinical outcomes. METHODS This retrospective study analyzed data of 234 patients with P. aeruginosa bacteremia at a 1,200-bed tertiary teaching university hospital in South Korea between January 2010 and December 2012. Factors associated with mortality were determined. Mortality was compared in patients with adequate empirical and targeted combination therapy, and monotherapy, and inappropriate therapy. RESULTS A total of 141 (60.3%) patients were given appropriate empirical antibiotic treatment (combination therapy in 38 and monotherapy in 103). Among 183 patients (78.2%) who finally received appropriate targeted treatment, 42 had combination therapy and 141 had monotherapy. The percentage of patients receiving empirical combination therapy was slightly, but not significantly higher, in the survivor group than in the nonsurvivor group (17.0% [31/182] vs. 13.5% [7/52], p = 0.74). A similar tendency was demonstrated for targeted combination therapy (19.8% [36/182] vs. 11.5% [6/52], respectively; p = 0.31). However, in a subgroup analysis of data from patients (n = 54) with an absolute neutrophil count less than 500/mm3, the patients who had appropriate empirical or targeted combination therapy showed better outcomes than those who underwent monotherapy or inappropriate therapy (p < 0.05). Mechanical ventilation (odds ratio [OR], 6.93; 95% confidence interval [CI], 2.64-18.11; p = 0.0001), the use of a central venous catheter (OR, 2.95; 95% CI, 1.35-6.43; p = 0.007), a high Acute Physiology and Chronic Health Evaluation II score (OR, 4.65; 95% CI, 1.95-11.04; p = 0.0001), and presence of septic shock (OR, 2.91; 95% CI, 1.33-6.38; p = 0.007) were independent risk factors for 14-day mortality. CONCLUSIONS Disease severity was a critical factor for mortality in our patients with P. aeruginosa bacteremia. Overall, combination therapy had no significant effect on 14-day mortality compared with monotherapy. However, appropriate combination therapy showed a favorable effect on survival in patients with febrile neutropenia.
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Affiliation(s)
| | | | | | | | | | - Ji Young Kang
- Division of Pulmonology, Department of Internal Medicine, Seoul St, Mary's hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
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Salih Z, Cavet J, Dennis M, Somervaille T, Bloor A, Kulkarni S. Prognostic factors for mortality with fungal blood stream infections in patients with hematological and non-hematological malignancies. South Asian J Cancer 2014; 2:220-4. [PMID: 24455639 PMCID: PMC3889042 DOI: 10.4103/2278-330x.119920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: This single center retrospective analysis was undertaken to identify the incidence, clinical impact, and prognostic factors for mortality associated with fungal blood stream infections (BSI) in cancer patients. Materials and Methods: One hundred and twenty four patients had 169 episodes of fungal BSI. Incidence has not changed over a 10 year period but non albicans candida species are the predominant fungal isolates. Mortality with fungal BSI was significantly higher than that with other microbial agents. Risk of mortality was associated with renal dysfunction and Candida albicans as the isolate. Type of chemotherapy, patient characteristics, and neutrophil count did not influence the mortality following fungal BSI. Conclusion: Fungal BSI is rare and the incidence has not changed in this hospital. Mortality associated with fungal BSI is high. Risk score at the time of developing fungal BSI has prognostic potential to identify patients with higher risk of mortality associated with fungal BSI.
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Affiliation(s)
- Zena Salih
- The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, UK
| | - Jim Cavet
- The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, UK
| | - Mike Dennis
- The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, UK
| | - Tim Somervaille
- The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, UK
| | - Adrian Bloor
- The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, UK
| | - Samar Kulkarni
- The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, UK
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The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection 2013; 42:5-13. [PMID: 23975584 DOI: 10.1007/s15010-013-0525-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/13/2013] [Indexed: 01/03/2023]
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