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Bloodstream infections and mortality-related factors in febrile neutropenic cancer patients.

Horasan ES, Ersoz G, Tombak A, Tiftik N, Kaya A - Med. Sci. Monit. (2011)

Bottom Line: Multivariate analyses showed that MASCC risk scores (p=0.0001, OR=15.1, CI%95 4.5-50.7), ICU wards (p=0.0002, OR= 8.6, Cl%95 1.101-68,157) and CoNS (p=0.004, OR=12.12, CI%95 2.3-64.7) were independent risk factors associated with mortality.BSI due to CoNS was associated with lower mortality; however, MASCC high risk score and ICU stay were associated with higher mortality.The MASCC risk-index score and emergence of CoNS in positive blood cultures are valuable tools in the management of FN.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Microbiology and Infectious Diseases, Mersin University, Faculty of Medicine, Mersin, Turkey. sahinelif@gmail.com

ABSTRACT

Background: We performed a prospective observational cohort study to evaluate the causative bacteria and to identify risk factors for mortality in febrile neutropenic (FN) patients with blood stream infection (BSI).

Material/methods: We conducted a prospective data collection on all patients with bacteremia or fungemia. The patients were assigned into low-risk and high-risk groups in accordance with the Multinational Association for Supportive Care in Cancer (MASCC) Risk Index.

Results: Throughout the study period, the patients developed 420 FN episodes. Out of 420 episodes, only 90 (21.4%) were found to have bloodstream infection. The mean age of the patients was 45.6±18.4 years and 55.6% of the patients were male. A total of 98 isolates were recovered from the cases of BSI. Coagulase-negative Staphylococcus spp (CoNS) were the most common isolates overall (33.7%). There was a significant increase in the rate of gram-negative bacteria throughout the study period (p=0.028). Overall mortality was 33%. Multivariate analyses showed that MASCC risk scores (p=0.0001, OR=15.1, CI%95 4.5-50.7), ICU wards (p=0.0002, OR= 8.6, Cl%95 1.101-68,157) and CoNS (p=0.004, OR=12.12, CI%95 2.3-64.7) were independent risk factors associated with mortality. BSI due to CoNS was associated with lower mortality; however, MASCC high risk score and ICU stay were associated with higher mortality.

Conclusions: The MASCC risk-index score and emergence of CoNS in positive blood cultures are valuable tools in the management of FN.

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Related in: MedlinePlus

Percent of gram positive and gram negative bacteremia throughout the study period.
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f1-medscimonit-17-5-cr304: Percent of gram positive and gram negative bacteremia throughout the study period.

Mentions: Gram-positive bacteria were more frequently isolated than gram-negative bacteria throughout the study period. Table 2 shows the distribution of causative bacteria. Coagulase-negative Staphylococcus (CoNS) spp. was the most common bloodstream isolate overall (33.7%), followed by E. coli (21.4%). Gram-negative bacteria were found in 30.7% of the isolates in 2004 and 2005, 42.8% of the isolates in 2006 and 2007, and 62.8% of the isolates in 2008 and 2009. The distribution of BSI episodes (n=90) according to study years were 26 episodes (28.9%) in 2004–5; 21 (23.3%) episodes in 2006–7 and 43 (47.8%) episodes in 2008–9. Percent of gram-positive bacteremia (n=42) according to study years were 18 (42.9%) episodes in 2004–5; 10 (23.8%) episodes in 2006–7, and 14 (33.3%) episodes in 2008–9. Occurrence of gram-negative bacteremia (n=44) according to study years was 8 (18.2%) episodes in 2004–5, 9 (20.5%) episodes in 2006–7, and 27 (61.4%) episodes in 2008–9 (Figure 1). There was a significant increase in the rate of gram-negative bacteria throughout the study period (p=0.028); in fact, there was a striking increase, especially in the rate of acinetobacteria (p=0.029). Acinetobacteria were not found (0%) in the first 2 years of the study, comprised 4.7% of the isolates in the second 2 years of the study, and 18.6% of the isolates in the third 2 years of the study (Figure 2). Thirty-five microorganisms isolated (35.7%) were MDR.


Bloodstream infections and mortality-related factors in febrile neutropenic cancer patients.

Horasan ES, Ersoz G, Tombak A, Tiftik N, Kaya A - Med. Sci. Monit. (2011)

Percent of gram positive and gram negative bacteremia throughout the study period.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539578&req=5

f1-medscimonit-17-5-cr304: Percent of gram positive and gram negative bacteremia throughout the study period.
Mentions: Gram-positive bacteria were more frequently isolated than gram-negative bacteria throughout the study period. Table 2 shows the distribution of causative bacteria. Coagulase-negative Staphylococcus (CoNS) spp. was the most common bloodstream isolate overall (33.7%), followed by E. coli (21.4%). Gram-negative bacteria were found in 30.7% of the isolates in 2004 and 2005, 42.8% of the isolates in 2006 and 2007, and 62.8% of the isolates in 2008 and 2009. The distribution of BSI episodes (n=90) according to study years were 26 episodes (28.9%) in 2004–5; 21 (23.3%) episodes in 2006–7 and 43 (47.8%) episodes in 2008–9. Percent of gram-positive bacteremia (n=42) according to study years were 18 (42.9%) episodes in 2004–5; 10 (23.8%) episodes in 2006–7, and 14 (33.3%) episodes in 2008–9. Occurrence of gram-negative bacteremia (n=44) according to study years was 8 (18.2%) episodes in 2004–5, 9 (20.5%) episodes in 2006–7, and 27 (61.4%) episodes in 2008–9 (Figure 1). There was a significant increase in the rate of gram-negative bacteria throughout the study period (p=0.028); in fact, there was a striking increase, especially in the rate of acinetobacteria (p=0.029). Acinetobacteria were not found (0%) in the first 2 years of the study, comprised 4.7% of the isolates in the second 2 years of the study, and 18.6% of the isolates in the third 2 years of the study (Figure 2). Thirty-five microorganisms isolated (35.7%) were MDR.

Bottom Line: Multivariate analyses showed that MASCC risk scores (p=0.0001, OR=15.1, CI%95 4.5-50.7), ICU wards (p=0.0002, OR= 8.6, Cl%95 1.101-68,157) and CoNS (p=0.004, OR=12.12, CI%95 2.3-64.7) were independent risk factors associated with mortality.BSI due to CoNS was associated with lower mortality; however, MASCC high risk score and ICU stay were associated with higher mortality.The MASCC risk-index score and emergence of CoNS in positive blood cultures are valuable tools in the management of FN.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Microbiology and Infectious Diseases, Mersin University, Faculty of Medicine, Mersin, Turkey. sahinelif@gmail.com

ABSTRACT

Background: We performed a prospective observational cohort study to evaluate the causative bacteria and to identify risk factors for mortality in febrile neutropenic (FN) patients with blood stream infection (BSI).

Material/methods: We conducted a prospective data collection on all patients with bacteremia or fungemia. The patients were assigned into low-risk and high-risk groups in accordance with the Multinational Association for Supportive Care in Cancer (MASCC) Risk Index.

Results: Throughout the study period, the patients developed 420 FN episodes. Out of 420 episodes, only 90 (21.4%) were found to have bloodstream infection. The mean age of the patients was 45.6±18.4 years and 55.6% of the patients were male. A total of 98 isolates were recovered from the cases of BSI. Coagulase-negative Staphylococcus spp (CoNS) were the most common isolates overall (33.7%). There was a significant increase in the rate of gram-negative bacteria throughout the study period (p=0.028). Overall mortality was 33%. Multivariate analyses showed that MASCC risk scores (p=0.0001, OR=15.1, CI%95 4.5-50.7), ICU wards (p=0.0002, OR= 8.6, Cl%95 1.101-68,157) and CoNS (p=0.004, OR=12.12, CI%95 2.3-64.7) were independent risk factors associated with mortality. BSI due to CoNS was associated with lower mortality; however, MASCC high risk score and ICU stay were associated with higher mortality.

Conclusions: The MASCC risk-index score and emergence of CoNS in positive blood cultures are valuable tools in the management of FN.

Show MeSH
Related in: MedlinePlus