Abstract
ObjectivesTo assess the current incidence, clinical features, risk factors, aetiology, antimicrobial resistance and outcomes of polymicrobial bloodstream infection (PBSI) in patients with cancer.MethodsAll prospectively collected episodes of PBSI in hospitalised patients were compared with episodes of monomicrobial bloodstream infection (MBSI) between 2006 and 2015.ResultsWe identified 194 (10.2%) episodes of PBSI and 1702 MBSI (89.8%). The presence of cholangitis, biliary stenting, neutropenia, corticosteroids, neutropenic enterocolitis and other abdominal infections were identified as risk factors for PBSI. Overall, Gram-negative organisms were the most frequent aetiology, but Enterococcus spp. were especially frequent causes of Gram-positive PBSI (30.8%). Multidrug-resistant (MDR) organisms were more commonly found in PBSI than in MBSI (20.6% vs 12.9%; p = 0.003). Compared to patients with MBSI, those with PBSI presented with higher early (15% vs 1.4%; p = 0.04) and overall (32% vs 20.9%; p<0.001) case-fatality rates. Risk factors for overall case-fatality were a high-risk MASCC (Multinational Association of Supportive Care in Cancer) index score, corticosteroid use, persistent bacteraemia and septic shock.ConclusionsPBSI is a frequent complication in patients with cancer and is responsible for high mortality rates. Physicians should identify patients at risk for PBSI and provide empiric antibiotic therapy that covers the most frequent pathogens involved in these infections, including MDR strains.
Highlights
Bloodstream infection (BSI) is a frequent complication in patients with cancer and results in important levels of morbidity and mortality [1]
The presence of cholangitis, biliary stenting, neutropenia, corticosteroids, neutropenic enterocolitis and other abdominal infections were identified as risk factors for polymicrobial BSI (PBSI)
Multidrug-resistant (MDR) organisms were more commonly found in PBSI than in monomicrobial bloodstream infection (MBSI) (20.6% vs 12.9%; p = 0.003)
Summary
Bloodstream infection (BSI) is a frequent complication in patients with cancer and results in important levels of morbidity and mortality [1]. Infections due to MDR bacteria is an emerging problem in immunosuppressed patients with cancer, who are at higher for severe sepsis and poor outcomes than their immunocompromised peers [4,5,6]. Patients with cancer and chemotherapy-induced neutropenia, gastrointestinal mucositis, and medical devices in situ are at increased risk of BSI [7]. In this setting, BSI may be caused by multiple organisms in which the clinical presentation, microbiology and outcomes can vary from those caused by only one pathogen. The lack of consistent PBSI definitions and the heterogeneity of populations in the previous studies makes it very difficult to understand the true relevance of PBSI [14]
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