Nivanka De Silva1, Justin Jackson1,2, Christopher Steer1,2,3. 1. Faculty of Medicine, University of New South Wales (UNSW) Rural Clinical School, Albury Campus, Albury, New South Wales, Australia. 2. Albury Wodonga Health, Albury, New South Wales, Australia. 3. Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, New South Wales, Australia.
Abstract
BACKGROUND: Infections and antibiotic resistance patterns in patients attending regional Australian cancer centres are poorly described. AIMS: To document patient characteristics, infection types, patterns of antibiotic resistance and outcomes in all patients with cancer requiring inpatient management for suspected infection at a regional Australian cancer centre. METHODS: We studied patients ≥18 years of age who were admitted under the oncology unit at Albury Wodonga Health during a 12-month period and who had a microbiological test performed for suspected infection during their admission. Data were extracted retrospectively from electronic records and analysed through descriptive statistics. RESULTS: We identified 275 episodes of suspected infection occurring in 208 patients (M/F: 61%/39%). Median age was 68 years, solid tumour 76%, haematological malignancy 24%. A positive culture was obtained in 28% of cases: Gram-positive 48.5% and Gram-negative 51.5%. Drug resistant Pseudomonas aeruginosa was seen in 38% (5/13) of pseudomonas isolates, three times the rate seen in general hospital admissions. Extended spectrum beta lactamase was seen in 22% of Gram-negative isolates. Empiric IV antibiotic choice was guideline concordant in 61% of neutropenic fever (NF) (NF) presentations. Only 17% of NF presentations received antibiotics within the recommended hour of emergency department triage. The inpatient mortality rate was 3%. Fifty-seven percent of NF presentations satisfied Multinational Association of Supportive Care in Cancer risk index criteria for outpatient management. CONCLUSIONS: This is the first study of this type in patients with cancer at an Australian regional cancer centre. The study highlighted key areas for improvement in antibiotic prescription and control of antibiotic resistance at our institution.
BACKGROUND: Infections and antibiotic resistance patterns in patients attending regional Australian cancer centres are poorly described. AIMS: To document patient characteristics, infection types, patterns of antibiotic resistance and outcomes in all patients with cancer requiring inpatient management for suspected infection at a regional Australian cancer centre. METHODS: We studied patients ≥18 years of age who were admitted under the oncology unit at Albury Wodonga Health during a 12-month period and who had a microbiological test performed for suspected infection during their admission. Data were extracted retrospectively from electronic records and analysed through descriptive statistics. RESULTS: We identified 275 episodes of suspected infection occurring in 208 patients (M/F: 61%/39%). Median age was 68 years, solid tumour 76%, haematological malignancy 24%. A positive culture was obtained in 28% of cases: Gram-positive 48.5% and Gram-negative 51.5%. Drug resistant Pseudomonas aeruginosa was seen in 38% (5/13) of pseudomonas isolates, three times the rate seen in general hospital admissions. Extended spectrum beta lactamase was seen in 22% of Gram-negative isolates. Empiric IV antibiotic choice was guideline concordant in 61% of neutropenic fever (NF) (NF) presentations. Only 17% of NF presentations received antibiotics within the recommended hour of emergency department triage. The inpatient mortality rate was 3%. Fifty-seven percent of NF presentations satisfied Multinational Association of Supportive Care in Cancer risk index criteria for outpatient management. CONCLUSIONS: This is the first study of this type in patients with cancer at an Australian regional cancer centre. The study highlighted key areas for improvement in antibiotic prescription and control of antibiotic resistance at our institution.