Jake C Valentine1,2,3, Lisa Hall4,5, Tim Spelman4,6, Karin M Verspoor4,7, John F Seymour8, Danny Rischin9, Karin A Thursky4,10,11,12, Monica A Slavin4,10,11,12, Leon J Worth4,10,11,12,13. 1. National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. jvalentine@student.unimelb.edu.au. 2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. jvalentine@student.unimelb.edu.au. 3. Paediatric Integrated Cancer Service, Royal Children's Hospital, Parkville, Victoria, Australia. jvalentine@student.unimelb.edu.au. 4. National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 5. School of Public Health, University of Queensland, Brisbane, Queensland, Australia. 6. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 7. School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia. 8. Department of Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Victoria, Australia. 9. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 10. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. 11. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 12. Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 13. Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Abstract
PURPOSE: Patients with cancer are at increased risk for infection, but the relative morbidity and mortality of all infections is not well understood. The objectives of this study were to determine the prevalence, incidence, time-trends and risk of mortality of infections associated with hospital admissions in patients with haematological- and solid-tumour malignancies over 11 years. METHODS: A retrospective, longitudinal cohort study of inpatient admissions between 1 January 2007 and 31 December 2017 at the Peter MacCallum Cancer Centre was conducted using administratively coded and patient demographics data. Descriptive analyses, autoregressive integrated moving average, Kaplan-Meier and Cox regression modelling were applied. RESULTS: Of 45,116 inpatient hospitalisations consisting of 3033 haematological malignancy (HM), 18,372 solid tumour neoplasm (STN) patients and 953 autologous haematopoietic stem cell transplantation recipients, 67%, 29% and 88% were coded with ≥ 1 infection, respectively. Gastrointestinal tract and bloodstream infections were observed with the highest incidence, and bloodstream infection rates increased significantly over time in both HM- and STN-cohorts. Inpatient length of stay was significantly higher in exposed patients with coded infection compared to unexposed in HM- and STN-cohorts (22 versus 4 days [p < 0.001] and 15 versus 4 days [p < 0.001], respectively). Risk of in-hospital mortality was higher in exposed than unexposed patients in the STN-cohort (adjusted hazard ratio [aHR] 1.61 [95% CI 1.41-1.83]; p < 0.001)) and HM-cohort (aHR 1.30 [95% CI 0.90-1.90]; p = 0.166). CONCLUSION: Infection burden among cancer patients is substantial and findings reflect the need for targeted surveillance in high-risk patient groups (e.g. haematological malignancy), in whom enhanced monitoring may be required to support infection prevention strategies.
PURPOSE:Patients with cancer are at increased risk for infection, but the relative morbidity and mortality of all infections is not well understood. The objectives of this study were to determine the prevalence, incidence, time-trends and risk of mortality of infections associated with hospital admissions in patients with haematological- and solid-tumour malignancies over 11 years. METHODS: A retrospective, longitudinal cohort study of inpatient admissions between 1 January 2007 and 31 December 2017 at the Peter MacCallum Cancer Centre was conducted using administratively coded and patient demographics data. Descriptive analyses, autoregressive integrated moving average, Kaplan-Meier and Cox regression modelling were applied. RESULTS: Of 45,116 inpatient hospitalisations consisting of 3033 haematological malignancy (HM), 18,372 solid tumour neoplasm (STN) patients and 953 autologous haematopoietic stem cell transplantation recipients, 67%, 29% and 88% were coded with ≥ 1 infection, respectively. Gastrointestinal tract and bloodstream infections were observed with the highest incidence, and bloodstream infection rates increased significantly over time in both HM- and STN-cohorts. Inpatient length of stay was significantly higher in exposed patients with coded infection compared to unexposed in HM- and STN-cohorts (22 versus 4 days [p < 0.001] and 15 versus 4 days [p < 0.001], respectively). Risk of in-hospital mortality was higher in exposed than unexposed patients in the STN-cohort (adjusted hazard ratio [aHR] 1.61 [95% CI 1.41-1.83]; p < 0.001)) and HM-cohort (aHR 1.30 [95% CI 0.90-1.90]; p = 0.166). CONCLUSION:Infection burden among cancerpatients is substantial and findings reflect the need for targeted surveillance in high-risk patient groups (e.g. haematological malignancy), in whom enhanced monitoring may be required to support infection prevention strategies.
Authors: Sarah Weber; Aaron Magh; Michael Hogardt; Volkhard A J Kempf; Maria J G T Vehreschild; Hubert Serve; Sebastian Scheich; Björn Steffen Journal: Ann Hematol Date: 2021-05-03 Impact factor: 3.673