Bloodstream infection (BSI) is a common complication in patients with solid tumor malignancies but available information on risk factors associated with BSI among these patients is scarce. To determine the associated risk factors and clinical outcomes of antibiotic treatment in BSI solid tumor malignancies. This was a retrospective case-control study performed in the National Care Centre. Adult patients with solid tumor malignancy and positive for blood culture bacteria growth (n=130) as well as adult patients with solid tumor malignancy and negative for blood culture bacteria growth were included (n=130). The most common form of solid malignancy (n=260) are those associated with digestive organs (n=72, 27.7%) and breast tumors (n=57, 21.9%). From 130 patients that were positive for BSI, gram-negative infection occurred in 71.5% (n=93) of the cases, mainly due to Klebsiella pneumoniae (n=31, 21.5%), Escherichia coli (n=24, 16.7%), and Pseudomonas aeruginosa (n=17, 11.8%). 98.2% (n=128) of BSI patients received empirical antimicrobial therapy while 58.5% (n=76) received adequate empirical antibiotic coverage. Elevated CRP levels (Adjusted OR=1.009; 95%CI=1.003–1.015; p=0.002) and total lymphocyte counts of <0.8x109/L (Adjusted OR=3.980; 95%CI=1.567–10.108; p=0.004) were found to be independent risk factors of BSI in solid tumor malignancy. There was no significant association between adequacy of empirical antibiotic coverage with the length of hospital stay (p=0.149), 48-hours all-cause mortality (p=0.255), and 28-days all-cause mortality (p=0.676). Close monitoring of the CRP elevation and presence of total lymphocyte counts <0.8x109/L may be used to determine the high risk for BSI in solid tumor malignancy patients.
1. Montassier E, Batard E, Gastinne T, Potel G, de La Cochetière MF. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance. Eur J Clin Microbiol Infect Dis. 2013;32(7):841-50.
2. Gudiol C, Aguado JM, Carratalà J. Bloodstream infections in patients with solids. Virulence. 2016;7(3):298-308.
3. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376(23):2235-44.
4. Babady NE. Laboratory diagnosis of infections in cancer patients: challenges and opportunities. J Clin Microbiol. 2016;54(11):2635-46.
5. Ogawara D, Fukuda M, Ueno S, Ohue Y, Takemoto S, Mizoguchi K, et al. Drug fever after cancer chemotherapy is most commonly observed on posttreatment days 3 and 4. Support Care Cancer. 2016;24(2):615-9.
6. Marín M, Gudiol C, Garcia-Vidal C, Ardanuy C, Carratalà J. Bloodstream infections in patients with solids: epidemiology, antibiotic therapy, and outcomes in 528 episodes in a single cancer center. Medicine (Baltimore). 2014;93(3):143-9.
7. Anatoliotaki M, Valatas V, Mantadakis E, Apostolakou H, Mavroudis D, Georgoulias V, et al. Bloodstream infections in patients with solids: associated factors, microbial spectrum, and outcome. Infection. 2004;32(2):65-71.
8. Farber IM, Kudryashova MA, Galstyan LA, Shatalina SI. Current aspects of antibacterial drug administration when treating nosocomial Pneumonia. J Adv Pharm Edu Res. 2021;11(1):29-34.
9. Ashjaran A, Sheybani S. Drug Release of Bacterial Cellulose as Antibacterial Nano Wound Dressing. Int J Pharm Res Allied Sci. 2019;8(3):137-43.
10. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2011;52:e56-93.
11. Baden LR, Swaminathan S, Angarone M, Blouin G, Camins BC, Casper C, et al. Prevention and treatment of cancer-related infections, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14(7):882-913.
12. World Health Organization. International classification of diseases for oncology (ICD-O) 3rd edition. World Health Organization. 2013.
13. Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol. 2018;36(30):3043-54.
14. Gonzalez H, Hagerling C, Werb Z. Roles of the immune system in cancer: from initiation to metastatic progression. Genes Dev. 2018;32(19-20):1267-84.
15. Allin KH, Nordestgaard BG. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci. 2011;48(4):155-70.
16. Zacho J, Benfield T, Tybjærg-Hansen A, Nordestgaard BG. Increased baseline C-reactive protein concentrations are associated with increased risk of infections: results from 2 large Danish population cohorts. Clin Chem. 2016;62(2):335-42.
17. Zhao Z, Li X, Zhao Y, Wang D, Li Y, Liu L, et al. Role of C-reactive protein and procalcitonin in discriminating between infectious fever and fever in non-neutropenic lung cancer patients. Medicine (Baltimore). 2018;97(33):e11930.
18. Yaegashi H, Izumi K, Kitagawa Y, Kadono Y, Konaka H, Mizokami A. Differential diagnosis between bacterial infection and neoplastic fever in patients with advanced urological cancer: the role of procalcitonin. Int J Urol. 2014;21(1):104-6.
19. Liaw CC, Huang JS, Chen JS, Chang JW, Chang HK, Liau CT. Using vital sign flow sheets can help to identify neoplastic fever and other possible causes in oncology patients: a retrospective observational study. J Pain Symptom Manage. 2010;40(2):256-65.
20. Poetker DM, Reh DD. A comprehensive review of the adverse effects of systemic corticosteroids. Otolaryngol Clin North Am. 2010;43(4):753-68.
21. Tolaney SM, Najita J, Winer EP, Burstein HJ. Lymphopenia associated with adjuvant anthracycline/taxane regimens. Clin Breast Cancer. 2008;8(4):352-6.
22. Dupont G, Flory L, Morel J, Lukaszewicz AC, Patoir A, Presles E. Postoperative lymphopenia: an independent risk factor for postoperative pneumonia after lung cancer surgery, results of a case-control study. PLoS One. 2018;13(10):e0205237.
23. Terrones C, Specht L, Maraldo MV, Lundgren J, Helleberg M. Lymphopenia after radiotherapy and risk of infection. Open Forum Infect Dis. 2017;4(suppl_1):S702.
24. Ministry of Health. Malaysian Antibiotic Guideline 2014. Ministry of Health, Malaysia. 2014.
25. Gross PA, Barrett TL, Dellinger EP, Krause PJ, Martone WJ, Mcgowan JE, et al. Quality standard for the treatment of bacteremia. The Infectious Diseases Society of America. Clin Infect Dis. 1994;18(3):428-30.
26. 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.
27. Koupetori M, Retsas T, Antonakos N, Vlachogiannis G, Perdios I, Nathanail C, et al. Bloodstream infections and sepsis in Greece: over-time change of epidemiology and impact of de-escalation on final outcome. BMC Infect Dis. 2014;14(1):272.