Bacteremia in Cancer Patients as a Prognostic Factor and the Relationship with Chemotherapy
Main Article Content
Abstract
Introduction: Bacteremia is a cause of morbi-mortality in cancer patients, due to its severity, longer hospital stays, chemotherapy withdraw, and increased costs. The study aimed to clarify if bacteriemia in cancer patients is associated with higher mortality rates and alert the community to this emerging problem.
Methods: The authors collected every cancer patient hospitalized in our cancer center, who developed bacteremia during their stay in hospital or at admission, in the last 9 years. Data was treated with SPSS. The p-values <0.05 were considered to be statistically significant.
Results: From 204 bloodstream infections, almost half of the patients had gastrointestinal cancer (49%). Males were predominant (54,4%) and the median age was 66 years-old. The catheter-totally-implanted was responsible in 38,7% of the cases. From all bacteria, 20,5% were multidrug-resistant and 48% were resistant to at least one antibiotic. From all patients, 61,5% received chemotherapy the month before the infection. The survival of those that did received chemotherapy was significantly different from patients that did not, t(203)= 2,06, p=0,04. Chemotherapy the month before was correlated with lower survival rates, r(203)=-0,15, p=0,03, and Kaplan-Meyer curve showed a tendency towards statistically significance (p=0,06). The stage of the oncologic disease was not associated with the mortality of the patient (p>0,05). The infection contributed or was the cause of death in 45% of the patients. The 3 months mortality rate of the patients that had bacteriemia was 74,5%.
Conclusion: Currently there are no guidelines regarding prescription of antimicrobial therapy in cancer patients. Three quarters of the cancer patients that suffer bacteriemia died in 3 months, and active chemotherapy treatment is associated with lower survival rates.
Keywords: oncology; bloodstream infection; multidrug-resistant bacteria; antibiotic stewardship.
Keywords:
oncology, bloodstream infection, multidrug-resistant bacteria, antibiotic stewardship
Article Details
How to Cite
MACEDO, Filipa et al.
Bacteremia in Cancer Patients as a Prognostic Factor and the Relationship with Chemotherapy.
Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3501>. Date accessed: 20 apr. 2024.
doi: https://doi.org/10.18103/mra.v10i12.3501.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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29. Allaway Z, Phillips RS, Thursky KA, Haeusler GM. Nonneutropenic fever in children with cancer: A scoping review of management and outcome. Pediatr Blood Cancer. 2019; 66(6):e27634.
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31. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29:1303-1310.
32. Torres VB, Azevedo LC, Silva UV, Caruso P, Torelly AP, Silva E, et al. Sepsis – Associated Outcomes in Critically Ill Patients with Malignancies. Ann Am Thorac Soc. 2015; 12(8):1185-92.
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34. Raad I, Hachem R, Hanna H, Bahna P, Chatzinikolaou I, Fang X, Jiang Y, Chemaly RF, Rolston K. Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters. Eur J Clin Microbiol Infect Dis. 2007; 26(8):549-56.
35. Islas-Muñoz B, Volkow-Fernández P, Ibanes-Gutiérrez C, Villamar-Ramírez A, Vilar-Compte D, Cornejo-Juárez P. Bloodstream infections in cancer patients. Risk factors associated with mortality. Int J Infect Dis. 2018; 71:59-64.
36. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium - a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol. 2013; 31(22):2810-8.
37. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay É. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med. 2007; 35:808–814.
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2. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. 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. 1992; 101 (6):1644-55.
3. Laupland KB, Church DL. Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev. 2014; 27(4):647-64.
4. Marín M, Gudiol C, Ardanuy C, García-Vidal C, Calvo M, Arnan M, et al. Bloodstream infections in neutropenic patients with cancer: differences between patients with haematological malignancies and solid tumours. J Infect. 2014; 69, pp. 417-423.
5. Montassier E, Batard E, Gastinne T, Potel G, La Cochetière M. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance. Eur J Clin Microbiol Infect Dis. 2013; 32 pp. 841-850
6. Irfan S, Idrees F, Mehraj V, Habib F, Adil S, Hasan R. Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: a descriptive study. BMC Infect Dis. 2008; 8:80
7. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis. 2003; 36:1103–1110
8. Gudiol C, Albasanz-Puig A, Cuervo G, Carratalà J. Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance. Front. Med. 2021; 8:636547.
9. Mouncey PR, Osborn TM, Power GS et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–11.
10. Peake SL, Delaney A, Bailey M et al., ARISE Investigators; ANZICS Clinical Trials Group. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371: 1496–506.
11. Allegretta GJ, Weisman SJ, Altman A. Oncologic emergencies II. Hematologic and infectious complications of cancer and cancer treatment. Pediatr Clin North Am. 1985; 32:613-624
12. Conlon C. Sepsis in immunocompromised hosts. J R Coll Physicians Lond. 2000; 34:533-536.
13. Hartnett S. Septic shock in the oncology patient. Cancer Nurs. 1989; 12:191–201.
14. Williams M, Braun L, Cooper L, Johnston J, Weiss R, Qualy R, Linde-Zwirble W. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004; 8(5): R291–R298.
15. Lee JH, Kim MU, Kim ET, Shim DJ, Kim IJ, Byeon JH, Kim HB. Prevalence and predictors of peripherally inserted central venous catheter associated bloodstream infections in cancer patients: A multicentre cohort study. Medicine. 2020; 99(6):e19056.
16. Sasaki T, Harada S, Yamamoto S, Ohkushi D, Hayama B, Takeda K, Hoashi K, Shiotani J, Takehana K, Doi Y. Clinical characteristics of peripheral venous catheter-associated gram-negative bloodstream infection among patients with malignancy. PLoS One. 2020; 30;15(1):e0228396.
17. Carena AA, Laborde A, Roccia-Rossi I, Palacios CJ, Jordán R, Valledor A, et al. Proposal of a clinical score to stratify the risk of multidrug-resistant gram-negative rods bacteremia in cancer patients. Braz J Infect Dis. 2020; 24(1):34-43.
18. Ota A, Morita S, Matsuoka A, Shimokata T, Maeda O, Mitsuma A, et al. Detection of bacteria in blood circulation in patients receiving cancer chemotherapy. Int J Clin Oncol. 2020; 25(1):210-215.
19. Jiang M, Li CL, Pan CQ, Yu L. The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis. Support Care Cancer. 2020; 28(1):361-372.
20. Stoclin A, Rotolo F, Hicheri Y, Mons M, Chachaty E, Gachot B, et al. Ventilator-associated pneumonia and bloodstream infections in intensive care unit cancer patients: a retrospective 12-year study on 3388 prospectively monitored patients. Support Care Cancer. 2020; 28(1):193-200.
21. Garrido MM, Garrido RQ, Cunha TN, Ehrlich S, Martins IS. Comparison of epidemiological, clinical and microbiological characteristics of bloodstream infection in children with solid tumours and haematological malignancies. Epidemiol Infect. 2019; 147:e298.
22. Trecarichi EM, Giuliano G, Cattaneo C, Ballanti S, Criscuolo M, Candoni A, et al. Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey. PLoS One. 2019; 14(10):e0224465.
23. Dandoy CE, Kelley T, Gaur AH, Nagarajan R, Demmel K, Alonso PB, et al. Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients. Pediatr Blood Cancer. 2019; 66(12):e27978.
24. Lubwama M, Phipps W, Najjuka CF, Kajumbula H, Ddungu H, Kambugu JB, Bwanga F. Bacteremia in febrile cancer patients in Uganda. BMC Res Notes. 2019; 12(1):464.
25. Vinker-Shuster M, Stepensky P, Temper V, Shayovitz V, Masarwa R, Averbuch D. Gram-negative Bacteremia in Children With Hematologic Malignancies and Following Hematopoietic Stem Cell Transplantation: Epidemiology, Resistance, and Outcome. J Pediatr Hematol Oncol. 2019; 41(8):e493-e498.
26. Widmer AF, Kern WV, Roth JA, Dettenkofer M, Goetting T, Bertz H, Theilacker C; Hospital Infection Surveillance System for Patients with Hematologic/Oncologic Malignancies Study Group (ONKO-KISS). Early versus late onset bloodstream infection during neutropenia after high-dose chemotherapy for hematologic malignancy. Infection. 2019; 47(5):837-845.
27. Vahedian-Ardakani HA, Moghimi M, Shayestehpour M, Doosti M, Amid N. Bacterial Spectrum and Antimicrobial Resistance Pattern in Cancer Patients with Febrile Neutropenia. Asian Pac J Cancer Prev. 2019; 20(5):1471-1474.
28. Knight T, Glaser DW, Ching N, Melish M. Antibiotic Susceptibility of Bloodstream Isolates in a Pediatric Oncology Population: The Case for Ongoing Unit-specific Surveillance. J Pediatr Hematol Oncol. 2019; 41(5):e271-e276.
29. Allaway Z, Phillips RS, Thursky KA, Haeusler GM. Nonneutropenic fever in children with cancer: A scoping review of management and outcome. Pediatr Blood Cancer. 2019; 66(6):e27634.
30. Mohan M, Susanibar-Adaniya S, Buros A, Crescencio JCR, Burgess MJ, Lusardi K, et al. Bacteremias following autologous stem cell transplantation for multiple myeloma: Risk factors and outcomes. Transpl Infect Dis. 2019; 21(2):e13052.
31. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29:1303-1310.
32. Torres VB, Azevedo LC, Silva UV, Caruso P, Torelly AP, Silva E, et al. Sepsis – Associated Outcomes in Critically Ill Patients with Malignancies. Ann Am Thorac Soc. 2015; 12(8):1185-92.
33. Abou Dagher G, El Khuri C, Chehadeh AA, Chami A, Bachir R, Zebian D, Bou Chebl R. Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon. BMJ Open. 2017; 7(3):e013502.
34. Raad I, Hachem R, Hanna H, Bahna P, Chatzinikolaou I, Fang X, Jiang Y, Chemaly RF, Rolston K. Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters. Eur J Clin Microbiol Infect Dis. 2007; 26(8):549-56.
35. Islas-Muñoz B, Volkow-Fernández P, Ibanes-Gutiérrez C, Villamar-Ramírez A, Vilar-Compte D, Cornejo-Juárez P. Bloodstream infections in cancer patients. Risk factors associated with mortality. Int J Infect Dis. 2018; 71:59-64.
36. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium - a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol. 2013; 31(22):2810-8.
37. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay É. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med. 2007; 35:808–814.
38. Kochanek M, Schalk E, von Bergwelt-Baildon M, Beutel G, Buchheidt D, Hentrich M, et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2019; 98(5): 1051–1069.
39. Rittirsch D, Flierl MA, Ward PA. Harmful molecular mechanisms in sepsis. Nat Rev Immunol. 2008; 8:776–87.
40. Mendonça MA, Cunha FQ, Murta EF, Tavares-Murta BM. Failure of neutrophil chemotactic function in breats cancer patients treated with chemotherapy. Cancer Chemother Pharmacol. 2006; 57:663–70.