Abstract
To evaluate the prognostic factors in adult cancer patients with pneumococcal bacteremia, describe episode features and the phenotypic characteristics of the isolated strains. We evaluated the episodes in patients admitted to a cancer hospital between 2009 and 2015. The outcomes were defined as 48 h mortality and mortality within 10 days after the episode. The variables evaluated were: age, sex, ethnicity, ECOG, Karnofsky score, SOFA, cancer type, metastasis, chemotherapy, radiotherapy, neutropenia, previous antibiotic therapy, community or healthcare-acquired infection, comorbidities, smoking, pneumococcal vaccination, infection site, presence of fever, polymicrobial infection, antimicrobial susceptibility, serotype and treatment. 165 episodes were detected in 161 patients. The mean age was 61.3 years; solid tumors were the most prevalent (75%). 48 h and 10-day mortality were 21% (34/161) and 43% (70/161) respectively. The 48 h mortality- associated risk factors were SOFA and polymicrobial bacteremia; 10-day mortality-associated risk factors were fever, neutropenia, ECOG 3/4, SOFA and fluoroquinolones as a protective factor. Pneumococcal bacteremia presented high mortality in cancer patients, with prognosis related to intrinsic host factors and infection episodes features. Fluoroquinolone treatment, a protective factor in 10-day mortality, has potential use for IPDs and severe community-acquired pneumonia in cancer patients.
Highlights
To evaluate the prognostic factors in adult cancer patients with pneumococcal bacteremia, describe episode features and the phenotypic characteristics of the isolated strains
In patients with lung cancer, the risk of invasive pneumococcal disease (IPD) is 13.41 times compared to the general population, and this risk is much higher for multiple m yeloma[2]
IPDs cause high mortality in cancer patients compared to the general population, with reports of up to 40% within 7 days and 55% within 30 days after the first day of infection[3,4,5,6]
Summary
To evaluate the prognostic factors in adult cancer patients with pneumococcal bacteremia, describe episode features and the phenotypic characteristics of the isolated strains. Pneumococcal bacteremia presented high mortality in cancer patients, with prognosis related to intrinsic host factors and infection episodes features. Fluoroquinolone treatment, a protective factor in 10-day mortality, has potential use for IPDs and severe community-acquired pneumonia in cancer patients. The need for further studies is shown by the high prevalence of pneumococcal bacteremia in the population with cancer, the high morbimortality related to them and the scarce world literature on epidemiology, etiology and bacteremia outcomes in these patients. The objectives of this study were to evaluate prognostic factors in cancer patients in episodes of pneumococcal bacteremia and to describe the epidemiological, clinical and microbiological data, the phenotypic characteristics of the collected specimens (serotypes and antimicrobial resistance) and to correlate the S. pneumoniae serotypes with available vaccine coverage
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