Maite Antonio1, Carlota Gudiol2, Cristina Royo-Cebrecos3, Sara Grillo4, Carmen Ardanuy5, Jordi Carratalà3. 1. Department of Oncology, Institut Català d'Oncologia, l'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain. Electronic address: mantonio@iconcologia.net. 2. Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: cgudiol@iconcologia.net. 3. Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain. 4. Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain. 5. Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain; CIBERes (CIBER de Enfermedades Respiratorias), ISCIII, Madrid, Spain.
Abstract
PURPOSE: To assess the etiology, clinical features and outcomes of bacteremia in older patients with solid tumors. METHODS: All episodes of bacteremia in hospitalized patients with solid tumors were prospectively collected. Patients aged ≥70 years were compared to patients aged <70 years. Risk factors for case-fatality rates in older patients were identified. RESULTS: We compared 217 episodes of bacteremia involving older patients and 525 occurring in younger patients. Older patients had more frequently other comorbidities, but were less commonly neutropenic and carried less frequently central venous catheters. Bacteremia from an abdominal source was more common in patients ≥70, whereas an endogenous source and catheter-related infection were less frequently observed. Streptococcus bovis group (3.7% vs. 0.8%, p = .01) and Listeria monocytogenes (4.6% vs. 1.9%, p = .04) were more common in older patients, whereas coagulase-negative staphylococci were less frequently found (1.4% vs. 5.3% p = .01). Infection due to multi-drug resistant (MDR) strains was significantly higher in older patients (17.1% vs. 10.9%, p = .02), who in addition, presented higher overall mortality (35.4% vs 27.7%, p = .04). In older patients, lung tumor, neutropenia, and low grade fever were associated with early mortality, whereas comorbidities, corticosteroids, septic shock and inadequate empirical antibiotic therapy were associated with overall mortality. CONCLUSIONS: We identified remarkable differences in the etiology and sources of bacteremia between older and younger cancer patients with bacteremia. Older patients had more frequent infection due to MDR organisms and presented a higher overall mortality. Corticosteroids and inadequate empirical antibiotic therapy are modifiable factors associated with mortality.
PURPOSE: To assess the etiology, clinical features and outcomes of bacteremia in older patients with solid tumors. METHODS: All episodes of bacteremia in hospitalized patients with solid tumors were prospectively collected. Patients aged ≥70 years were compared to patients aged <70 years. Risk factors for case-fatality rates in older patients were identified. RESULTS: We compared 217 episodes of bacteremia involving older patients and 525 occurring in younger patients. Older patients had more frequently other comorbidities, but were less commonly neutropenic and carried less frequently central venous catheters. Bacteremia from an abdominal source was more common in patients ≥70, whereas an endogenous source and catheter-related infection were less frequently observed. Streptococcus bovis group (3.7% vs. 0.8%, p = .01) and Listeria monocytogenes (4.6% vs. 1.9%, p = .04) were more common in older patients, whereas coagulase-negative staphylococci were less frequently found (1.4% vs. 5.3% p = .01). Infection due to multi-drug resistant (MDR) strains was significantly higher in older patients (17.1% vs. 10.9%, p = .02), who in addition, presented higher overall mortality (35.4% vs 27.7%, p = .04). In older patients, lung tumor, neutropenia, and low grade fever were associated with early mortality, whereas comorbidities, corticosteroids, septic shock and inadequate empirical antibiotic therapy were associated with overall mortality. CONCLUSIONS: We identified remarkable differences in the etiology and sources of bacteremia between older and younger cancerpatients with bacteremia. Older patients had more frequent infection due to MDR organisms and presented a higher overall mortality. Corticosteroids and inadequate empirical antibiotic therapy are modifiable factors associated with mortality.
Authors: Ai-Min Jiang; Na Liu; Rim Ali Said; Meng-Di Ren; Huan Gao; Xiao-Qiang Zheng; Xiao Fu; Xuan Liang; Zhi-Ping Ruan; Yu Yao; Tao Tian Journal: Cancer Manag Res Date: 2020-06-25 Impact factor: 3.989