Comparative study of clinical characteristics of neutropenic and non-neutropenic adult cancer patients with bloodstream infections

  • E. Velasco
  • R. Byington
  • C. A. S. Martins
  • M. Schirmer
  • L. M C. Dias
  • V. M. S. C. Gonçalves
Article
First Online:

Abstract

A total of 399 consecutive episodes of bloodstream infections in adult patients with haematologic malignancies and solid tumours were evaluated prospectively over a 26-month period, with the aim of determining the clinical characteristics and the microbiological profile of the patients relative to neutrophil count. The overall 30-day mortality rate was 32% (35% in non-neutropenic patients vs. 26% in neutropenic patients, p=0.05). Main diagnoses were solid tumours (33%) and lymphoma (29%). Most of the episodes of bloodstream infection (58%) occurred in non-neutropenic patients. Acute leukaemia and bone marrow transplantation predominated in the neutropenic group. Non-neutropenic patients tended to be older and to have a higher frequency of solid tumours and advanced or uncontrolled diseases. Indwelling central venous catheters were present in 51% of the episodes, with a predominance of long-term catheters in neutropenic haematologic patients. Concomitant infections were observed more frequently in non-neutropenic patients. There were 1,040 noninfectious comorbid conditions, most of which were present in non-neutropenic patients. The causative pathogens were predominantly gram-negative bacilli (56%). Escherichia coli and Klebsiella pneumoniae were isolated more frequently from neutropenic patients, while Staphylococcus aureus and Acinetobacter spp. were more frequent in non-neutropenic patients. Seventy-four percent of the episodes of candidaemia occurred in patients with central venous catheters, with non-albicans strains predominating. The results of this study highlight the heterogeneity of cancer patients with bloodstream infections and the value of stratifying risk factors and aetiologic agents according to neutrophil count.

Keywords

Bloodstream Infection Neutropenic Patient Haematopoietic Stem Cell Transplantation Central Venous Access Aetiologic Agent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

We are grateful to Dr. Márcio Soares for his active participation in this manuscript. We thank the Clinical Microbiology and Mycology Laboratory at Hospital do Câncer, National Cancer Institute, for technical assistance.

References

  1. 1.
    Elting LS, Rubenstein EB, Rolston KVI, Bodey GP (1997) Outcomes of bacteremia in patients with cancer and neutropenia: observation from two decades of epidemiological and clinical trials. Clin Infect Dis 25:247–259PubMedCrossRefGoogle Scholar
  2. 2.
    Wisplinghoff H, Cornely AO, Moser S, Bethe U, Stützer H, Salzberger B, Fätkenheuer G, Seifert H (2003) Outcomes of nosocomial bloodstream infections in adult neutropenic patients: a prospective cohort and matched case-control study. Infect Control Hosp Epidemiol 24:905–911PubMedCrossRefGoogle Scholar
  3. 3.
    Pittet D, Tarara D, Wenzel RP (1994) Nosocomial bloodstream infection in critically ill patients. JAMA 271:1598–1601PubMedCrossRefGoogle Scholar
  4. 4.
    Spengler RF, Greenough WE III (1978) Hospital costs and mortality attributed to nosocomial bacteremias. JAMA 240:2455–2458PubMedCrossRefGoogle Scholar
  5. 5.
    Wisplinghoff H, Seifer H, Wenzel RP, Edmond MB (2003) Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematologic malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 36:1103–1110PubMedCrossRefGoogle Scholar
  6. 6.
    Jugo J, Kennedy R, Crowe MJ et al (2002) Trends in bacteraemia on the haematology and oncology units of a UK tertiary referral hospital. J Hosp Infect 50:48–55PubMedCrossRefGoogle Scholar
  7. 7.
    Velasco E, Byington R, Martins CAS, Schirmer M, Dias LCM, Gonçalves VMSC (2003) Prospective evaluation of the epidemiology, microbiology, and outcome of bloodstream infections in hematologic patients in a single cancer center. Eur J Clin Microbiol Infect Dis 22:137–143PubMedGoogle Scholar
  8. 8.
    Velasco E, Byington R, Martins CAS, Schirmer M, Dias LCM, Gonçalves VMSC (2004) Bloodstream infections surveillance in a cancer center: a prospective look at clinical microbiology aspects. Clin Microbiol Infect 10:542–549PubMedCrossRefGoogle Scholar
  9. 9.
    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections. Am J Infect Contr 16:128–140CrossRefGoogle Scholar
  10. 10.
    Sickles E, Greene W, Wiernik PH (1975) Clinical presentation of infection in granulocytopenic patients. Arch Intern Med 135:715–719PubMedCrossRefGoogle Scholar
  11. 11.
    Mermel LA, Farr BM, Sherertz RJ, Raad II, O’Grady N, Harris J, Craven DE (2001) Guidelines for management of intravascular catheter-related infections. Clin Infect Dis 32:1249–1272PubMedCrossRefGoogle Scholar
  12. 12.
    Karnofsky DA, Burchenot JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLead CM (ed) Evaluation of chemotherapeutic agents. Symposium, Microbiology Section, New York Academy of Medicine, New York, New York, 1948. Columbia University Press, New York, pp 191–205Google Scholar
  13. 13.
    World Health Organization (1979) Handbook for reporting results of cancer treatment. WHO, Geneva, pp 15–22Google Scholar
  14. 14.
    Miller JM, O’Hara CM (1995) Substrate utilization systems for the identification of bacteria and yeast. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH (eds) Manual of clinical microbiology. American Society for Microbiology, Washington, District of Columbia, pp 103–109Google Scholar
  15. 15.
    National Committee for Clinical Laboratory Standards (2000) Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard M7-A5. NCCLS, Wayne, PennsylvaniaGoogle Scholar
  16. 16.
    Klastersky J (2004) Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis 39:S32–S37PubMedCrossRefGoogle Scholar
  17. 17.
    Pompei P, Charlson ME, Ales K, MacKenzie CR, Norton M (1991) Relating patient characteristics at the time of admission to outcomes of hospitalization. J Clin Epidemiol 44:1063–1069PubMedCrossRefGoogle Scholar
  18. 18.
    Elting L, Cooksley C, Chambers M, Cantor S, Manzullo E, Rubenstein E (2003) The burdens of cancer therapy: clinical and economic outcomes of chemotherapy-induced mucositis, measurement, epidemiology, and consequences for patients. Cancer 98:1531–1539PubMedCrossRefGoogle Scholar
  19. 19.
    Diekema DJ, BootsMiller BJ, Vaughn TE, Woolson RF, Yankey JW, Ernst EJ, Flach SD, Ward MM, Franciscus CL, Pfaller MA, Doebbeling BN (2004) Antimicrobial resistance trends and outbreak frequency in United States hospitals. Clin Infect Dis 38:78–85PubMedCrossRefGoogle Scholar
  20. 20.
    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 32:381–390PubMedCrossRefGoogle Scholar
  21. 21.
    Feld R, DePauw B, Berman S, Keating A, Ho W (2000) Meropenen versus ceftazidime in the treatment of cancer patients with febrile neutropenia: a randomized double-blind trial. J Clin Oncol 18:3690–3698PubMedGoogle Scholar
  22. 22.
    Extermann M (2000) Measuring comorbidity in older cancer patients. Eur J Cancer 36:453–471PubMedCrossRefGoogle Scholar
  23. 23.
    Juthani-Mehta M, Quagliarello VJ (2004) Prognostic scoring system for infectious diseases: their applicability to the care of older adults. Clin Infect Dis 38:692–696PubMedCrossRefGoogle Scholar
  24. 24.
    Rossini F (1996) Prognosis of infections in elderly patients with hematological diseases. Support Care Cancer 4:46–50PubMedCrossRefGoogle Scholar
  25. 25.
    Cosgrove AS, Carmeli Y (2003) The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 36:1433–1437PubMedCrossRefGoogle Scholar
  26. 26.
    Lautenbach E, Patel JB, Bilker WB, Edesltein PH, Fishman NO (2001) Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 32:1162–1171PubMedCrossRefGoogle Scholar
  27. 27.
    Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Oh Md, Kim EC, Choe KW (2004) Bloodstream infections caused by Enterobacter species: predictors of 30-day mortality rate and impact of broad-spectrum cephalosporin resistance on outcome. Clin Infect Dis 39:812–818PubMedCrossRefGoogle Scholar
  28. 28.
    Vidal F, Mensa J, Almela M, Olona M, Martinez JÁ, Marco F, Lopez MJ, Soriano A, Horcajada JP, Gatell JM, Richart C (2003) Bacteraemia in adults due to glucose non-fermentative gram-negative bacilli other than P. aeruginosa. Q J Med 96:227–234Google Scholar
  29. 29.
    Martino R, Gomes L, Pericas R, Salazar R, Solá C, Sierra J, Garau J (2000) Bacteraemia caused by non-glucose fermenting gram-negative bacilli and Aeromonas species in patients with hematological malignancies and solid tumours. Eur J Clin Microbiol Infect Dis 19:320–323PubMedCrossRefGoogle Scholar
  30. 30.
    Viscoli C, Girmenia C, Marinus A, Collete L, Martino P, Vandercam B, Doyen C, Lebeau B, Spence D, Krcmery V, De Pauw B, Meunier F, and the Invasive Fungal Infection Group of the EORTC (1999) Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis 28:1071–1079PubMedCrossRefGoogle Scholar
  31. 31.
    Beck-Sagué CM, Jarvis WM, and the National Nosocomial Infections Surveillance System (1993) Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990. J Infect Dis 167:1247–1251PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • E. Velasco
    • 1
  • R. Byington
    • 2
  • C. A. S. Martins
    • 3
  • M. Schirmer
    • 3
  • L. M C. Dias
    • 3
  • V. M. S. C. Gonçalves
    • 3
  1. 1.Rua General Glicério 486/1002Rio de JaneiroBrazil
  2. 2.Hospital do Câncer, Instituto Nacional de CâncerRio de JaneiroBrazil
  3. 3.Hospital do Câncer, Instituto Nacional de Câncer, Comissão de Controle de Infecção HospitalarRio de JaneiroBrazil

Personalised recommendations