Abstract
Purpose
Time to positivity (TTP) has been used in recent years as a simple and rapid method for the additional characterization of the degree of bacteremia. However, prognostic factors for TTP in cancer patients with bloodstream infections have rarely been studied. The aim of this study was to investigate the clinical factors for TTP involving various isolated organisms in cancer patients.
Methods
We analyzed 386 episodes of bloodstream infections (BSIs) in patients with or without cancer during a 19 month period. Information on age, gender, tumor type, ICU stay, organisms, multidrug resistance (MDR), TTP and outcome was collected. Multivariate logistic regression analysis was performed.
Results
The mean TTP of Enterobacteriaceae in patients with hepatocellular carcinoma, gastroenterological cancer, and lung cancer was shorter than in non-cancer patients (9.86 ± 3.22, 10.05 ± 3.47, 8.85 ± 2.78 vs 13.11 ± 5.37 h). The mean TTP of nonfermentative bacilli in patients with lung cancer (12.37 ± 5.96 h) and hematologic diseases (8.72 ± 4.21 h) was also shorter than in non-cancer patients (20.74 ± 2.46 h), and the mean TTP of Staphylococcus isolates was significantly different between non-cancer patients (22.06 ± 3.71 h) and hematologic disease patients (11.93 ± 5.44 h). The presence of a benign tumor was a significant prognostic factor for a long TTP only in the Staphylococci group (OR 0.076, 95 % CI 0.014–0.412), according to multivariate analysis. MDR (OR 2.178, 95 % CI 1.196–4.239) was an independent significant predictor in the Enterobacteriaceae group, with a short TTP, and it was also a significant clinical factor for a long TTP in nonfermentative bacilli and the Staphylococci group (OR 5.037, 95 % CI 1.065–23.82; OR 0.167, 95 % CI 0.059–0.474).
Conclusion
Time to positivity provides useful diagnostic and prognostic information for the differentiation of frequently isolated organisms. This information may help clinicians to use the correct antibiotics in a timely manner to treat cancer patients with BSIs based on clinical factor analysis.
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References
Bos MM, Smeets LS, Dumay I, de Jonge E. Bloodstream infections in patients with or without cancer in a large community hospital. Infection. 2013;41:949–58.
Kempf VAJ, Trebesius K, Autenrieth IB. Fluorescent in situ hybridization allows rapid identification of microorganisms in blood cultures. J Clin Microbiol. 2000;38:830–8.
Gescher DM, Kovacevic D, Schmiedel D, Siemoneit S, Mallmann C, Halle E, et al. Fluorescenceinsituhybridization (FISH) accelerates identification of Gram-positive cocci in positive blood cultures. Int J Antimicrob Agents. 2008;32:S51–9.
Hammarström B, Nilson B, Laurell T, Nilsson J, Ekström S. Acoustic trapping for bacteria identification in positive blood cultures with MALDI-TOF MS. Anal Chem. 2014;86:10560–7.
Idelevich EA, Schüle I, Grünastel B, Wüllenweber J, Peters G, Becker K. Rapid identification of microorganisms from positive blood cultures by MALDI-TOF mass spectrometry subsequent to very short-term incubation on solid medium. Clin Microbiol Infect. 2014;20:1001–6.
Defrance G, Birgand G, Ruppé E, Billard M, Ruimy R, Bonnal C, et al. Time-to-positivity -based discrimination between Enterobacteriaceae, Pseudomonas aeruginosa and strictly anaerobic gram-negative bacilli in aerobic and anaerobic blood culture vials. J Microbiol Methods. 2013;93:77–9.
Hautala T, Syrjälä H, Lehtinen V, Kauma H, Kauppila J, Kujala P, et al. Blood culture gram stain and clinical categorization based empirical antimicrobial therapy of bloodstream infection. Int J Antimicrob Agents. 2005;25:329–33.
Uehara Y, Yagoshi M, Tanimichi Y, Yamada H, Shimoguchi K, Yamamoto S, et al. Impact of reporting gram stain results from blood culture bottles on the selection of antimicrobial agents. Am J Clin Pathol. 2009;132:18–25.
Souvenir D, Anderson DE Jr, Palpant S, Mroch H, Askin S, Anderson J, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol. 1998;36:1923–6.
Martínez JA, Soto S, Fabrega A, Almela M, Mensa J, Soriano A, et al. Relationship of phylogenetic background, biofilm production, and time to detection of growth in blood culture vials with clinical variables and prognosis associated with Escherichia coli bacteremia. J Clin Microbiol. 2006;44:1468–74.
Peralta G, Roiz MP, Sánchez MB, Garrido JC, Ceballos B, Rodríguez-Lera MJ, et al. Time-to-positivity in patients with Escherichia coli bacteraemia. Clin Microbiol Infect. 2007;13:1077–82.
Liao CH, Lai CC, Hsu MS, Huang YT, Chu FY, Hsu HS, et al. Correlation between time to positivity of blood cultures with clinical presentation and outcomes in patients with Klebsiella pneumoniae bacteraemia: prospective cohort study. Clin Microbiol Infect. 2009;15:1119–25.
Kim J, Gregson DB, Ross T, Laupland KB. Time to blood culture positivity in Staphylococcus aureus bacteremia: association with 30-day mortality. J Infect. 2010;61:197–204.
Álvarez R, Viñas-Castillo L, Lepe-Jiménez JA, García-Cabrera E, Cisneros-Herreros JM. Time to positivity of blood culture association with clinical presentation, prognosis and ESBL-production in Escherichia coli bacteremia. Eur J Clin Microbiol Infect Dis. 2012;31:2191–5.
Willmann M, Kuebart I, Vogel W, Flesch I, Markert U, Marschal M, et al. Time to positivity as prognostic tool in patients with Pseudomonas aeruginosa bloodstream infection. J Infect. 2013;67:416–23.
Kim SH, Yoon YK, Kim MJ, Sohn JW. Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia. J Antimicrob Chemother. 2013;68:2890–7.
Lin HW, Hsu HS, Huang YT, Yang CJ, Hsu MS, Liao CH. Time to positivity in blood cultures of adults with nontyphoidal Salmonella bacteremia. J Microbiol Immunol Infect. 2014. doi:10.1016/j.jmii.2014.08.004.
Seifert H, Cornely O, Seggewiss K, Decker M, Stefanik D, Wisplinghoff H, et al. Bloodstream infection in neutropenic cancer patients related to short-term non-tunneled catheters determined by quantitative blood cultures, differential time to positivity, and molecular epidemiological typing with pulsed field gel electrophoresis. J Clin Microbiol. 2003;41:118–23.
Chen WT, Liu TM, Wu SH, Tan TD, Tseng HC, Shih CC. Improving diagnosis of central venous catheter-related bloodstream infection by using differential time to positivity as a hospital-wide approach at a cancer hospital. J Infect. 2009;59:317–23.
Passerini R, Riggio D, Radice D, Bava L, Cassatella C, Salvatici M, et al. Interference of antibiotic therapy on blood cultures time-to-positivity: analysis of a 5-year experience in an oncological hospital. Eur J Clin Microbiol Infect Dis. 2009;28:95–8.
Freeman JT, Elinder-Camburn A, McClymont C, Anderson DJ, Bilkey M, Williamson DA, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol. 2013;34:89–92.
Guerti K, Devos H, Ieven MM, Mahieu LM. Time to positivity of neonatal blood cultures: fast and furious? J Med Microbiol. 2011;60:446–53.
Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationship between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64:328–40.
Bo SN, Bo J, Ning YZ, Zhao Y, Lu XL, Yang JY, et al. Relationship between time to positivity of blood culture with clinical characteristics and hospital mortality in patients with Escherichia coli bacteremia. Chin Med J (Engl). 2011;124:330–4.
Poole K. Efflux-mediated antimicrobial resistance. J Antimicrob Chemother. 2005;56:20–51.
Acknowledgments
We are grateful to Dr. Cameron McKay for reading and commenting on the manuscript. This work was supported by the National Natural Science Foundation of China (30700829, 81373318), the Specialized Research Fund for Doctoral Program of Higher Education of China (No. 20130031120037) and the Chinese National High Tech (863) Program (2011AA02A111).
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Zhang, Q., Li, D., Bai, C. et al. Clinical prognostic factors for time to positivity in cancer patients with bloodstream infections. Infection 44, 583–588 (2016). https://doi.org/10.1007/s15010-016-0890-2
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DOI: https://doi.org/10.1007/s15010-016-0890-2