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Bloodstream infections in adult patients with cancer: clinical features and pathogenic significance of Staphylococcus aureus bacteremia

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Abstract

Objectives

The aim of this study was to more precisely delineate the characteristics and outcomes of bloodstream infections in adult cancer patients.

Methods

Using a database for nationwide surveillance of bacteremia, we analyzed data related to bacteremia in adult patients with cancer in order to evaluate clinical features and outcomes and to define predictive factors for mortality.

Results

Of 1,246 patients, 896 (71.9%) had solid tumors, 328 (26.3%) had hematologic malignancies, and 22 (1.8%) had both. The following conditions were more common in the neutropenic group than in the non-neutropenic group: nosocomial acquisition, hematologic malignancy, corticosteroid use, immunosuppressant use, primary bacteremia, and pneumonia (all P < 0.05). The infections were caused by Gram-negative bacilli in 55.6% and by Gram-positive cocci in 32.7%. Gram-negative pathogens were more frequently isolated from neutropenic patients than from non-neutropenic patients (61.9% vs. 53.5%, P = 0.010), with a significant predominance of Escherichia coli and Klebsiella pneumoniae. Among 1,001 patients whose outcomes could be evaluated, the overall 30-day mortality rate was 24.1%, and multivariate analysis showed that Staphylococcus aureus bacteremia was a significant factor associated with mortality (odds ratio (OR), 1.80; 95% confidence interval (CI), 1.03–3.15), along with nosocomial acquisition, pneumonia, severe sepsis or septic shock, and higher Pitt bacteremia score (all P values <0.05).

Conclusion

This study represents the comprehensive assessment of bloodstream infections in neutropenic versus non-neutropenic cancer patients. Given the pathogenic significance of S. aureus bacteremia in adult patients with cancer, additional strategies for the management of S. aureus bacteremia in cancer patients are needed to improve outcomes.

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References

  1. Velasco E, Byington R, Martins CA, Schirmer M, Dias LM, Goncalves VM (2006) Comparative study of clinical characteristics of neutropenic and non-neutropenic adult cancer patients with bloodstream infections. Eur J Clin Microbiol Infect Dis 25:1–7

    Article  PubMed  CAS  Google Scholar 

  2. Safdar A, Rodriguez GH, Balakrishnan M, Tarrand JJ, Rolston KV (2006) Changing trends in etiology of bacteremia in patients with cancer. Eur J Clin Microbiol Infect Dis 25:522–526

    Article  PubMed  CAS  Google Scholar 

  3. Guven GS, Uzun O, Cakir B, Akova M, Unal S (2006) Infectious complications in patients with hematological malignancies consulted by the Infectious Diseases team: a retrospective cohort study (1997–2001). Support Care Cancer 14:52–55

    Article  PubMed  Google Scholar 

  4. Velasco E, Byington R, Martins CS, Schirmer M, Dias LC, Goncalves VM (2004) Bloodstream infection surveillance in a cancer centre: a prospective look at clinical microbiology aspects. Clin Microbiol Infect 10:542–549

    Article  PubMed  CAS  Google Scholar 

  5. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:427–431

    Article  PubMed  Google Scholar 

  6. Chen CY, Tsay W, Tang JL, Tien HF, Chen YC, Chang SC, Hsueh PR (2010) Epidemiology of bloodstream infections in patients with haematological malignancies with and without neutropenia. Epidemiol Infect 138:1044–1051

    Article  PubMed  Google Scholar 

  7. Klastersky J, Ameye L, Maertens J, Georgala A, Muanza F, Aoun M, Ferrant A, Rapoport B, Rolston K, Paesmans M (2007) Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents 30(Suppl 1):S51–S59

    Article  PubMed  CAS  Google Scholar 

  8. Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, Ki HK, Son JS, Lee SS, Kim YS, Jung SI, Kim SW, Chang HH, Ryu SY, Kwon KT, Lee H, Moon C, Shin SY (2010) Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli. Int J Antimicrob Agents 36:284–287

    Article  PubMed  CAS  Google Scholar 

  9. Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, Ki HK, Son JS, Lee SS, Kim YS, Jung SI, Kim SW, Chang HH, Ryu SY, Kwon KT, Lee H, Moon C (2011) Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia. J Infect 62:26–33

    Article  PubMed  Google Scholar 

  10. Son JS, Song JH, Ko KS, Yeom JS, Ki HK, Kim SW, Chang HH, Ryu SY, Kim YS, Jung SI, Shin SY, Oh HB, Lee YS, Chung DR, Lee NY, Peck KR (2010) Bloodstream infections and clinical significance of healthcare-associated bacteremia: a multicenter surveillance study in Korean hospitals. J Korean Med Sci 25:992–998

    Article  PubMed  Google Scholar 

  11. Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, Mulazimoglu L, Trenholme G, Klugman KP, Bonomo RA, Rice LB, Wagener MM, McCormack JG, Yu VL (2004) Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases. Clin Infect Dis 39:31–37

    Article  PubMed  CAS  Google Scholar 

  12. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655

    Article  PubMed  CAS  Google Scholar 

  13. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140

    Article  PubMed  CAS  Google Scholar 

  14. Kang CI, Song JH, Ko KS, Chung DR, Peck KR (2011) Clinical features and outcomes of Staphylococcus aureus infections in non-neutropenic cancer patients. Support Care Cancer (in press)

  15. Gonzalez-Barca E, Carratala J, Mykietiuk A, Fernandez-Sevilla A, Gudiol F (2001) Predisposing factors and outcome of Staphylococcus aureus bacteremia in neutropenic patients with cancer. Eur J Clin Microbiol Infect Dis 20:117–119

    PubMed  CAS  Google Scholar 

  16. Ghanem GA, Boktour M, Warneke C, Pham-Williams T, Kassis C, Bahna P, Aboufaycal H, Hachem R, Raad I (2007) Catheter-related Staphylococcus aureus bacteremia in cancer patients: high rate of complications with therapeutic implications. Medicine (Baltimore) 86:54–60

    Article  Google Scholar 

  17. Feld R, DePauw B, Berman S, Keating A, Ho W (2000) Meropenem versus ceftazidime in the treatment of cancer patients with febrile neutropenia: a randomized, double-blind trial. J Clin Oncol 18:3690–3698

    PubMed  CAS  Google Scholar 

  18. Winston DJ, Lazarus HM, Beveridge RA, Hathorn JW, Gucalp R, Ramphal R, Chow AW, Ho WG, Horn R, Feld R, Louie TJ, Territo MC, Blumer JL, Tack KJ (2001) Randomized, double-blind, multicenter trial comparing clinafloxacin with imipenem as empirical monotherapy for febrile granulocytopenic patients. Clin Infect Dis 32:381–390

    Article  PubMed  CAS  Google Scholar 

  19. Tumbarello M, Spanu T, Caira M, Trecarichi EM, Laurenti L, Montuori E, Fianchi L, Leone F, Fadda G, Cauda R, Pagano L (2009) Factors associated with mortality in bacteremic patients with hematologic malignancies. Diagn Microbiol Infect Dis 64:320–326

    Article  PubMed  Google Scholar 

  20. Cheong HS, Kang CI, Wi YM, Kim ES, Lee JS, Ko KS, Chung DR, Lee NY, Song JH, Peck KR (2008) Clinical significance and predictors of community-onset Pseudomonas aeruginosa bacteremia. Am J Med 121:709–714

    Article  PubMed  Google Scholar 

  21. Hyle EP, Lipworth AD, Zaoutis TE, Nachamkin I, Bilker WB, Lautenbach E (2005) Impact of inadequate initial antimicrobial therapy on mortality in infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae: variability by site of infection. Arch Intern Med 165:1375–1380

    Article  PubMed  Google Scholar 

  22. Gudiol C, Calatayud L, Garcia-Vidal C, Lora-Tamayo J, Cisnal M, Duarte R, Arnan M, Marin M, Carratala J, Gudiol F (2010) Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome. J Antimicrob Chemother 65:333–341

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health & Welfare, Republic of Korea (A102065). The authors would like to thank all participating investigators. KONSID members are as follows: Jae-Hoon Song, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck, Nam Yong Lee, and Yae Jean Kim (Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea); Kwan Soo Ko (Sungkyunkwan University School of Medicine, Suwon, South Korea); Joon-Sup Yeom (Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea); Yu Mi Wi (Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea); Hyun Kyun Ki and Hae Suk Cheong (Konkuk University Hospital, Seoul, South Korea); Jun Seong Son (Kyunghee University Hospital at Gangdong, Seoul, South Korea); Choon Kwan Kim (Seoul Veterans Hospital, Seoul, South Korea); Jin Seo Lee (Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea); Seung Soon Lee (Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea); Eun Seok Kim (Anyang Sam Hospital, Anyang, South Korea); Yeon-Sook Kim (Chungnam National University Hospital, Daejeon, South Korea); Ji-Young Rhee (Dankook University Hospital, Cheonan, South Korea); Sook-In Jung and Kyung Hwa Park (Chonnam National University Hospital, Gwangju, South Korea); Shin-Woo Kim and Hyun-Ha Chang (Kyungpook National University Hospital, Daegu, South Korea); Seong Yeol Ryu (Keimyung University Dongsan Medical Center, Daegu, South Korea); Ki Tae Kwon (Daegu Fatima Hospital, Daegu, South Korea); Hyuck Lee and Dong Sik Jung (Dong-A University Hospital, Busan, South Korea); Chisook Moon (Inje University Busan Paik Hospital, Busan, South Korea); Sang Taek Heo (Jeju National University Hospital, Jeju, South Korea); and Sang Yop Shin (National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea).

Conflicts of interest

There are no conflicts of interest for any of the authors.

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Authors and Affiliations

  1. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea

    Cheol-In Kang, Jae-Hoon Song, Doo Ryeon Chung & Kyong Ran Peck

  2. Division of Infectious Diseases, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Joon-Sup Yeom

  3. Division of Infectious Diseases, Kyung Hee University Hospital at Gangdong, Seoul, South Korea

    Jun Seong Son

  4. Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea

    Yu Mi Wi

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  1. Cheol-In Kang
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on behalf of the Korean Network for Study on Infectious Diseases (KONSID)

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Correspondence to Jae-Hoon Song.

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Kang, CI., Song, JH., Chung, D.R. et al. Bloodstream infections in adult patients with cancer: clinical features and pathogenic significance of Staphylococcus aureus bacteremia. Support Care Cancer 20, 2371–2378 (2012). https://doi.org/10.1007/s00520-011-1353-z

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  • DOI: https://doi.org/10.1007/s00520-011-1353-z

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