Predictors of mortality in bacteremic cancer patients: retrospective analysis of 64 deaths occurring among 262 bacteremic episodes

Abstract

A total of 262 bacteremic episodes were observed in cancer patients in a single cancer institution during the last 7 years, and the recorded outcome was death in 65. The 65 patients who died (24.8% overall mortality) were divided retrospectively into two subgroups: (a) those who died of underlying disease with bacteremia (45 cases, 16.9% crude mortality) and (b) those who died of bacteremia (20 patients, 7.7% attributable mortality). Comparison of several risk factors in subgroups of patients who achieved a cure (197 cases) and of those who died and whose deaths were attributable (20 cases) revealed six risk factors that were associated with attributable mortality: (1) chemotherapy-induced neutropenia (P < 0.03), (2) Acinetobacter/Stenotrophomonas spp. bacteremias (P < 0.001), (3) liver failure (P < 0.001), (4) inappropriate therapy (P < 0.0001), (5) organ complications (P < 0.003) and (6) multiresistant organisms (P < 0.001). Enterococci and Pseudomonas aeruginosa, surprisingly, were found more frequently in those who died of an underlying disease with bacteremia than among patients who were cured (17.6% vs 7.6%, P < 0.05 and 29.1% vs 13.8%, P < 0.02). Those who died of infection had higher numbers of positive blood cultures, with 2.05 per episode, than did those who died of underlying disease with bacteremia (1.82) or those who were cured (1.51). Other risk factors, such as underlying disease, type of chemotherapy, origin of bacteremia, age, and catheters did not predict either overall or attributable mortality within the study group.

Bloodstream Infections in Patients with Solid Tumors: Associated Factors, Microbial Spectrum and Outcome

“…Previous studies in patients with solid tumors report mortality rates of approximately 25% [1,36]. In the present study, the infectious mortality attributable to BSIs was 20%.…”

“…In fact, the presence of shock and the administration of appropriate initial empirical antibiotic therapy were the two factors more closely associated with unfavorable and favorable outcome, respectively. The prognostic importance of these factors has also been shown in several other studies [1,2,4,13,35,36].…”

Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

“…The comparison is between three options:no antibiotic prophylactic regimens, vancomycin or ciprofloxacin and amoxicillin-clavulonic acid. However, it is not randomised Reuter 2005 Not an RCT, a prospective observational study Risi 1998 A review article Schaison 1991 A study of febrile neutropenia Solano 2005 Not a randomised trial - a prospective study of prophylaxis compared with historical controls Spanik 1998 A retrospective trial Takemoto 1990 A randomised controlled trial but for febrile neutropenia Timmer-Bonte 2005 A randomised controlled trial, but the intervention was granulocyte colony-stimulating factor and both arms received prophylactic antibiotics Tjan Heijnen 2002 A letter relating to another trial Tunkel 2002 A review article Van De Leur 1995 A study which evaluates antibiotic concentration in faeces, but not in neutropenics, not a RCT Viscoli 2001 A review article Viscoli 1998 A review article Viscoli 2002 A review article von Baum 2006 Controlled before and after observational study of prophylaxis but not randomised von Minckwitz 2008 This study compared four consecutive cohort studies of patients receiving chemotherapy for breast cancer, it was not randomised. The 4 methods of neutropenia prophylaxis administered were : ciprofloxacin alone vs figrastim vs. pegfilgratim vs pegfilgradtim+ciprofloxacin Wade 1981 A retrospective study…”

Systemic inflammatory response syndrome in adult patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa

“…1 The crude mortality of P. aeruginosa BSI in immunocompromised patients ranges from 22 to 33%. 2 A higher incidence of multidrug-resistant P. aeruginosa isolates has been described principally in intensive care units, 3,4 where there is heavy use of broad-spectrum anti-microbials, in particular carbapenems. 5 Many studies have investigated risk factors for mortality and the influence of adequate anti-microbial therapy on clinical outcome for P. aeruginosa infections.…”