Omar Yaxmehen Bello-Chavolla1,2, Jessica Paola Bahena-Lopez1,2, Pamela Garciadiego-Fosass2,3, Patricia Volkow2, Alejandro Garcia-Horton2,4, Consuelo Velazquez-Acosta5, Diana Vilar-Compte6. 1. PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico. 2. Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico. 3. Department of Adult Intensive Care Unit, Instituto Nacional de Perinatologia, Mexico City, Mexico. 4. Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada. 5. Microbiology Laboratory, Instituto Nacional de Cancerología, Mexico City, Mexico. 6. Department of Infectious Diseases, Instituto Nacional de Cancerología, San Fernando 22, Sección XVI; Tlalpan, CP 14080,, Mexico City, Mexico. diana_vilar@yahoo.com.mx.
Abstract
BACKGROUND: Staphylococcus aureus bloodstream infections (SABIs) represent a significant cause of morbidity and mortality in cancer patients. In this study, we compared infection characteristics and evaluated epidemiology and risk factors associated to SABIs and 30-day attributable mortality in cancer patients. METHODS: Clinical and microbiological data from patients with cancer and positive blood cultures for S. aureus were retrieved during a 10-year period at an oncology reference center. Analyses were performed according to type of malignancy and infection with methicillin-resistant S. aureus (MRSA). Data was evaluated using competing risk analyses to identify risk factors associated to 30-day mortality and used to create a point system for mortality risk stratification. RESULTS: We included 450 patients and MRSA was documented in 21.1%. Hospital-acquired infection, healthcare-associated pneumonia, and type-2 diabetes were associated to MRSA. In patients with hematologic malignancies, MRSA was more frequent if hospital-acquired, but less likely in primary bacteremia. Variables associated to mortality included abdominal source of infection, hematologic malignancy, MRSA, glucose levels > 140 mg/dL, and infectious endocarditis; catheter removal and initiation of adequate treatment within 48 h of positive blood culture were protective factors. From our designed mortality prediction scale, patients with a score > 3 had a 70.23% (95%CI 47.2-85.3%) probability of infection-related death at 30 days. CONCLUSION: SABIs are a significant health burden for cancer patients. Risk factors for SABI-related mortality in this population are varied and impose a challenge for management to improve patient's outcomes. Risk stratification might be useful to evaluate 30-day mortality risk.
BACKGROUND:Staphylococcus aureus bloodstream infections (SABIs) represent a significant cause of morbidity and mortality in cancerpatients. In this study, we compared infection characteristics and evaluated epidemiology and risk factors associated to SABIs and 30-day attributable mortality in cancerpatients. METHODS: Clinical and microbiological data from patients with cancer and positive blood cultures for S. aureus were retrieved during a 10-year period at an oncology reference center. Analyses were performed according to type of malignancy and infection with methicillin-resistant S. aureus (MRSA). Data was evaluated using competing risk analyses to identify risk factors associated to 30-day mortality and used to create a point system for mortality risk stratification. RESULTS: We included 450 patients and MRSA was documented in 21.1%. Hospital-acquired infection, healthcare-associated pneumonia, and type-2 diabetes were associated to MRSA. In patients with hematologic malignancies, MRSA was more frequent if hospital-acquired, but less likely in primary bacteremia. Variables associated to mortality included abdominal source of infection, hematologic malignancy, MRSA, glucose levels > 140 mg/dL, and infectious endocarditis; catheter removal and initiation of adequate treatment within 48 h of positive blood culture were protective factors. From our designed mortality prediction scale, patients with a score > 3 had a 70.23% (95%CI 47.2-85.3%) probability of infection-related death at 30 days. CONCLUSION:SABIs are a significant health burden for cancerpatients. Risk factors for SABI-related mortality in this population are varied and impose a challenge for management to improve patient's outcomes. Risk stratification might be useful to evaluate 30-day mortality risk.
Entities:
Keywords:
Cancer complications; Hematologic malignancies; Infection-related mortality in cancer; MRSA; Staphylococcus aureus bloodstream infection
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