A fresh look at polymicrobial bloodstream infection in cancer patients

Objectives: To assess the current incidence, clinical features, risk factors, aetiology, antimicrobial resistance and outcomes of polymicrobial bloodstream infection (PBSI) in patients with cancer. Methods: All prospectively collected episodes of PBSI in hospitalised patients were compared with epis...

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Bibliographic Details
Published inPloS one
Main Authors Royo-Cebrecos, Cristina, Gudiol González, Carlota, Ardanuy Tisaire, María Carmen, Pomares, Helena, Calvo, Mariona, Carratalà, Jordi
Format Journal Article
LanguageEnglish
Published Public Library of Science (PLoS) 24.10.2017
Subjects
Agents antiinfecciosos
Anti-infective agents
Anàlisi per injecció en flux
Cancer patients
Flow injection analysis
Malalts de càncer
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Summary:Objectives: To assess the current incidence, clinical features, risk factors, aetiology, antimicrobial resistance and outcomes of polymicrobial bloodstream infection (PBSI) in patients with cancer. Methods: All prospectively collected episodes of PBSI in hospitalised patients were compared with episodes of monomicrobial bloodstream infection (MBSI) between 2006 and 2015. Results: We identified 194 (10.2%) episodes of PBSI and 1702 MBSI (89.8%). The presence of cholangitis, biliary stenting, neutropenia, corticosteroids, neutropenic enterocolitis and other abdominal infections were identified as risk factors for PBSI. Overall, Gram-negative organisms were the most frequent aetiology, but Enterococcus spp. were especially frequent causes of Gram-positive PBSI (30.8%). Multidrug-resistant (MDR) organisms were more commonly found in PBSI than in MBSI (20.6% vs 12.9%; p = 0.003). Compared to patients with MBSI, those with PBSI presented with higher early (15% vs 1.4%; p = 0.04) and overall (32% vs 20.9%; p<0.001) case-fatality rates. Risk factors for overall case-fatality were a high-risk MASCC (Multinational Association of Supportive Care in Cancer) index score, corticosteroid use, persistent bacteraemia and septic shock. Conclusions PBSI is a frequent complication in patients with cancer and is responsible for high mortality rates. Physicians should identify patients at risk for PBSI and provide empiric antibiotic therapy that covers the most frequent pathogens involved in these infections, including MDR strains.
ISSN:1932-6203
1932-6203