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A fresh look at polymicrobial bloodstream infection in cancer patients
Cristina Royo-Cebrecos1,2, Carlota Gudiol1,2, Carmen Ardanuy3,4
1Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.
Objectives:
To assess the current incidence, clinical features, risk factors, aetiology, antimicrobial resistance and outcomes of polymicrobial bloodstream infection (PBSI) in patients with cancer.
Methods:
All prospectively collected episodes of PBSI in hospitalised patients were compared with episodes of monomicrobial bloodstream infection (MBSI) between 2006 and 2015.
Results:
We 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.
Conclusions:
PBSI 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.
Insights
Polymicrobial bloodstream infections (PBSI) are common in cancer patients and lead to higher mortality. Early identification of risk factors and appropriate antibiotic therapy, including for multidrug-resistant (MDR) strains, are crucial for improving outcomes.
Area of Science:
- Infectious Diseases
- Oncology
- Clinical Microbiology
Background:
- Polymicrobial bloodstream infection (PBSI) is a significant concern in immunocompromised patients.
- Understanding the epidemiology and risk factors of PBSI in cancer patients is critical for effective management.
Purpose of the Study:
- To evaluate the incidence, clinical characteristics, risk factors, etiology, antimicrobial resistance, and outcomes of PBSI in cancer patients.
- To compare PBSI with monomicrobial bloodstream infection (MBSI) in this population.
Main Methods:
- Prospective collection and comparison of PBSI and MBSI episodes in hospitalized cancer patients from 2006 to 2015.
- Analysis of risk factors, causative pathogens, antimicrobial resistance patterns, and case-fatality rates.
Main Results:
- PBSI occurred in 10.2% of bloodstream infections, with risk factors including cholangitis, biliary stenting, neutropenia, and corticosteroid use.
- Gram-negative organisms were most frequent, but Enterococcus spp. were common in Gram-positive PBSI. Multidrug-resistant (MDR) organisms were more prevalent in PBSI (20.6%) than MBSI (12.9%).
- PBSI was associated with significantly higher early (15% vs 1.4%) and overall (32% vs 20.9%) case-fatality rates compared to MBSI.
Conclusions:
- PBSI is a frequent and high-mortality complication in cancer patients.
- Identifying patients at risk for PBSI is essential.
- Empiric antibiotic therapy should target common pathogens, including MDR strains, to improve patient outcomes.
