Bacteremia In Cancer Patients Research Articles

Polymicrobial bacteremia in cancer patients: analysis of risk factors, etiology and outcome in 214 episodes

Two hundred and fourteen episodes of polymicrobial bacteremia in 182 cancer patients in a period of 6 years in a 360-bed National Cancer Institute were analyzed for etiology, risk factors and outcome. Variables were compared with 187 episodes of monomicrobial bacteremias in 147 cancer patients to find statistical significance among risk factors, etiology and outcome. Urinary catheters and breakthrough bacteremia were the only risk factors associated with polymicrobial in comparison to monomicrobial bacteremia ( P < 0.05). Concerning etiology, Enterococcus faecalis, Candida spp., Acinetobacter calcoaceticus and Stenotrophomonas maltophilia were more commonly isolated in polymicrobial than in monomicrobial bacteremic episodes. Polymicrobial bacteremia presented more frequently with septic shock (22.9% vs. 9.0%, P < 0.05) and/or organ complications (25.2% vs. 11.8%, P < 0.05). However, mortality due to bacteremia did not significantly differ between polymicrobial and monomicrobial, but when polymicrobial bacteremia with and without coagulase negative staphylococci were compared, mortality in polymicrobial bacteremia without staphylococci was higher (10% vs. 4.7%, P < 0.04).

Review ofCitrobacter bacteremia in cancer patients over a sixteen-year period

A review was conducted of 65 episodes of Citrobacter bacteremia in cancer patients during a 16-year period. Cases of polymicrobial bacteremia were excluded from this analysis. The infection occurred most commonly in patients with acute leukemia. Most patients acquired the infection in the hospital, and 57% had received antibiotic therapy during the preceding ten days. Fever occurred in 98% of cases and shock in 17%. Thirty-eight percent of patients had concomitant pneumonia. Patients with shock, pneumonia or hemorrhage had a substantially poorer prognosis. The response rate was 72% for patients who received appropriate antibiotics. Patients who continued to have positive blood culture results while receiving appropriate antibiotic therapy had a poor prognosis. Beta-lactam antibiotics were more effective than aminoglycosides.

Clostridial bacteremia in cancer patients. A 12-year experience

Over 12 years, 136 episodes of bacteremia caused by clostridial species were documented. Eighty-three were monomicrobial, and 53 were polymicrobial. Gastrointestinal, genitourinary carcinomas, and acute leukemia were the most common underlying malignancies. Septic shock occurred in 29% of monomicrobial bacteremias and 45% of polymicrobial bacteremias and was associated with a high mortality rate. Acute hemolysis, gas gangrene, and diffuse spreading cellulitis occurred infrequently but were associated with a 100% fatality rate. Many infections caused by Clostridium perfringens and C. septicum were associated with abdominal disease. The most commonly isolated organism was C. perfringens, followed by C. septicum and C. sporogenes. Overall survival was 58%, but it was 66% for monomicrobial episodes and 45% for polymicrobial infections. All of the patients with bacteremia due to an aerobic gram-negative bacillus in addition to the clostridial species died of their infection. The most effective antibiotics were clindamycin, penicillin, metronidazole, and moxalactam. Surgical drainage of abscesses was an important component of therapy.

Serratia bacteremia: review of 118 cases.

A review was conducted of 118 episodes of serratia bacteremia in cancer patients during a 16-year period. The infection occurred most commonly in patients with acute leukemia. Most patients acquired the infection in the hospital, and 61% had received antibiotic therapy during the preceding 10 days. Fever occurred in 90% of cases and shock in 18%. Thirty-eight percent of patients had concomitant pneumonia. Patients with shock, pneumonia, or hemorrhage had a substantially poorer prognosis. The response rate was 75% for patients who received appropriate antibiotics, 22% for those who received inappropriate antibiotics, and 29% for those who received no antibiotics. Patients who continued to have positive blood culture results while receiving appropriate antibiotic therapy had a poor diagnosis. Patients who received only an aminoglycoside had the poorest response rate among those who received appropriate therapy.

In vitro assessment of sulbactam plus cefoperazone in the treatment of bacteria isolated from cancer patients

Cefoperazone is a broad-spectrum cephalosporin that has been used extensively to treat infections in cancer patients. A recent survey demonstrated only a 6% resistance to this drug among Gram-negative bacteria. The combination of cefoperazone plus sulbactam was studied in vitro against consecutive isolates causing bacteremia in cancer patients as well as those selected for resistance to cefoperazone. Both a fixed ratio of sulbactam/cefoperazone (2:1 w/w) and selected concentrations of sulbactam (2, 4, 8, and 16 μg/ml) were studied. Sulbactam was shown to increase the susceptibility of various unselected Gram-negative bacilli; this effect increased with larger concentrations of sulbactam. The addition of sulbactam at optimum concentration levels made 29 of 65 cefoperazone-resistant Gram-negative bacilli susceptible. This effect was seen most markedly for Acinetobacter spp.

Pneumococcal bacteremia in cancer patients.

Twenty-eight episodes of Streptococcus pneumoniae bacteremia occurring in 27 cancer patients hospitalized in the Institut Jules Bordet between July 1979 and April 1985 were reviewed. Ten patients had hematological malignancies and 17 had solid tumors (in 7 cases, of the lung). Forty-four per cent of the patients were neutropenic (less than 1000/microliters) and 36% of the patients were in septic shock. In 36% of the patients no clinical source of S. pneumoniae bacteremia could be found. Seventy-nine (21% patients) received empirical antibiotic treatment containing a beta-lactam. Two patients who did not receive any empirical treatment died within 12 hours. Overall, 11/27 patients died within the first week, and 8/27 died within the first three days. Mortality in neutropenic patients was not different from that in non-neutropenic patients. In comparison with a similar study performed previously in our institution, there was no difference in incidence, type of patient, source of bacteremia, or mortality.

The relationship of fever, granulocytopenia and antimicrobial therapy to bacteremia in cancer patients

The relationship of fever, granulocytopenia, and antimicrobial therapy to bacteremia was studied retrospectively in 53 cancer patients. Severe granulocytopenia was present at the time blood cultures were positive in 27 to 31 episodes of bacteremia. Twenty-five episodes of bacteremia documented before the initiation of antimicrobial therapy in patients who were granulocytopenic and febrile. No bacteremia occurred in the absence of fever. Only two bacteremias occured while patients were receiving parenteral antimicrobials. Antimicrobial therapy was terminated 30 times in the presence of granulocytopenia and fever, and subsequent bacteremia occurred in 14 patients within 4 days. Patients who died with fungal disease did not receive more antibiotics than patients who died without fungal disease. These data suggest a rationale for long-term use of antimicrobial therapy in patients with persistent granulocytopenia and fever.

Klebsiella bacteremia in cancer patients.

Klebsiella bacteremia in cancer patients.