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Kitaya S, Kanamori H, Ishii R, Katsumi M, Ikeda R, Higashi K, Kakuta R, Ohkoshi A, Katori Y. Clinical characteristics and outcomes of persistent bacteremia in patients with head and neck cancer in a tertiary care hospital. Front Med (Lausanne) 2024; 11:1406983. [PMID: 38983366 PMCID: PMC11232632 DOI: 10.3389/fmed.2024.1406983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction Compared to other cancers, research on bloodstream infection in head and neck cancer is scarce, lacking comparative studies on persistent versus transient bacteremia outcomes. Methods This retrospective survey examined patients with head and neck cancer undergoing blood culture at our center from June 2009 to May 2023. Blood culture-positive cases suspected of infection were divided into persistent bacteremia and transient bacteremia groups. We investigated their clinical, epidemiological, and microbiological features, including risk factors for persistent bacteremia and mortality. The primary outcome was 90-day mortality. Results In this 97-patient cohort, 14 (14%) cases were assigned to the persistent bacteremia group. Catheter-related bloodstream infections were the leading cause of infection in both groups, consistently contributing to a high proportion of overall bloodstream infections. The mortality rate was generally higher in the persistent bacteremia group than in the transient bacteremia group (odds ratio [OR], 2.6; 95% confidence interval [CI], 0.6-11.1), particularly in the non-clearance subgroup (OR, 9; 95% CI, 0.5-155.2). Pyogenic spondylitis was a key risk factor for persistent bacteremia, while hypoalbuminemia increased mortality. Conclusion In patients with bacteremia and head and neck cancer, persistent bacteremia was associated with higher mortality than was transient bacteremia. Adittionally, bacteremia clearance in persistent bacteremia is thus crucial for prognostic improvement.
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Affiliation(s)
- Shiori Kitaya
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ishii
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Katsumi
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Iwate Medical University, Shiwa, Iwate, Japan
| | - Kenjiro Higashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Rühle A, Zou J, Glaser M, Halle L, Gkika E, Schäfer H, Knopf A, Becker C, Grosu AL, Popp I, Nicolay NH. The influence of antibiotic administration on the outcomes of head-and-neck squamous cell carcinoma patients undergoing definitive (chemo)radiation. Eur Arch Otorhinolaryngol 2023; 280:2605-2616. [PMID: 36764957 PMCID: PMC10066162 DOI: 10.1007/s00405-023-07868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Effects of antibiotic administration on patients' microbiome may negatively influence cancer outcomes, and adverse prognoses after antibiotic application have been demonstrated for cancer patients receiving immune checkpoint inhibitors. While the microbiome may play an important role also in head-and-neck squamous cell carcinoma (HNSCC), the prognostic value of antibiotic treatment here is largely unknown. We therefore analyzed whether antibiotic prescription is associated with impaired oncological outcomes of HNSCC patients undergoing definitive (chemo)radiation. METHODS A cohort of 220 HNSCC patients undergoing definitive (chemo)radiation between 2010 and 2019 was analyzed. The influence of antibiotic administration on locoregional control, progression-free survival (PFS) and overall survival (OS) was determined using Kaplan-Meier and Cox analyses. RESULTS A total of 154 patients were treated with antibiotics within 30 days before (chemo)radiation (pretherapeutic) or during (chemo)radiation (peritherapeutic). While antibiotic prescription was not associated with age, ECOG, tumor localization or radiotherapy characteristics, patients treated with antibiotics had significantly higher tumor stages. Peritherapeutic antibiotic administration diminished PFS (HR = 1.397, p < 0.05, log-rank test) and OS (HR = 1.407, p < 0.05), whereas pretherapeutic administration did not. Antibiotic application was an independent prognosticator for OS (HR = 1.703, p < 0.05) and PFS (HR = 1.550, p < 0.05) in the multivariate Cox analysis within the subgroup of patients aged < 75 years. CONCLUSION Peritherapeutic antibiotic usage was associated with impaired oncological outcomes in HNSCC patients undergoing (chemo)radiation. Further studies including microbiome analyses are required to elucidate underlying mechanisms.
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Affiliation(s)
- Alexander Rühle
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Jiadai Zou
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Margaretha Glaser
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Lennard Halle
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Henning Schäfer
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology, University of Freiburg-Medical Center, Freiburg, Germany
| | - Christoph Becker
- Department of Otorhinolaryngology, University of Freiburg-Medical Center, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ilinca Popp
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg-Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Huang CH, Chou YF, Hsieh TC, Chen PR. Association of Neutrophil-to-Lymphocyte Ratio and Bloodstream Infections with Survival after Curative-Intent Treatment in Elderly Patients with Oral Cavity Squamous Cell Carcinoma. Diagnostics (Basel) 2023; 13:diagnostics13030493. [PMID: 36766596 PMCID: PMC9914317 DOI: 10.3390/diagnostics13030493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
Patients with oral cavity squamous cell carcinoma (OSCC) undergoing curative-intent treatment may become immunocompromised. This study aimed to investigate the association of pretreatment sarcopenia, nutritional status, comorbidities, and blood-based inflammation prognostic biomarkers in bloodstream infection (BSI) with survival status in elderly patients with OSCC. Retrospective data were collected from 235 patients who were newly diagnosed with OSCC, were aged ≥ 65 years, had undergone curative-intent treatment, and were classified into either the BSI group or the no-BSI group within 6 months after surgery and/or adjuvant therapy initiation. Of the 235 elderly patients, 27 presented with BSI episodes. A preoperative high neutrophil-to-lymphocyte ratio (NLR) was a significant independent risk factor for BSI. BSI was not significantly associated with survival status. Ever betel nut chewing, hypoalbuminemia, and advanced tumor stage were associated with shorter overall survival. Moreover, a high NLR was an independent risk factor associated with disease-free survival. A high NLR was associated with BSI and resistance to curative-intent treatment. Pretreatment of NLR could act as an independent prognostic indicator and help inform treatment strategies for older patients with OSCC.
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Affiliation(s)
- Chun-Hou Huang
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Yu-Fu Chou
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970374, Taiwan
- School of Medicine, College of Medicine, Tzu Chi University, Hualien 970473, Taiwan
| | - Tsung-Cheng Hsieh
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan
| | - Peir-Rong Chen
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970374, Taiwan
- School of Medicine, College of Medicine, Tzu Chi University, Hualien 970473, Taiwan
- Correspondence:
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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: 2] [Impact Index Per Article: 1.0] [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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