Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Support Care Cancer. 2012 Oct;20(10):2371-8. doi: 10.1007/s00520-011-1353-z. Epub 2011 Dec 23.
The aim of this study was to more precisely delineate the characteristics and outcomes of bloodstream infections in adult cancer patients.
Using a database for nationwide surveillance of bacteremia, we analyzed data related to bacteremia in adult patients with cancer in order to evaluate clinical features and outcomes and to define predictive factors for mortality.
Of 1,246 patients, 896 (71.9%) had solid tumors, 328 (26.3%) had hematologic malignancies, and 22 (1.8%) had both. The following conditions were more common in the neutropenic group than in the non-neutropenic group: nosocomial acquisition, hematologic malignancy, corticosteroid use, immunosuppressant use, primary bacteremia, and pneumonia (all P < 0.05). The infections were caused by Gram-negative bacilli in 55.6% and by Gram-positive cocci in 32.7%. Gram-negative pathogens were more frequently isolated from neutropenic patients than from non-neutropenic patients (61.9% vs. 53.5%, P = 0.010), with a significant predominance of Escherichia coli and Klebsiella pneumoniae. Among 1,001 patients whose outcomes could be evaluated, the overall 30-day mortality rate was 24.1%, and multivariate analysis showed that Staphylococcus aureus bacteremia was a significant factor associated with mortality (odds ratio (OR), 1.80; 95% confidence interval (CI), 1.03-3.15), along with nosocomial acquisition, pneumonia, severe sepsis or septic shock, and higher Pitt bacteremia score (all P values <0.05).
This study represents the comprehensive assessment of bloodstream infections in neutropenic versus non-neutropenic cancer patients. Given the pathogenic significance of S. aureus bacteremia in adult patients with cancer, additional strategies for the management of S. aureus bacteremia in cancer patients are needed to improve outcomes.
本研究旨在更精确地描绘成人癌症患者血流感染的特征和结局。
我们使用一个全国性的菌血症监测数据库，分析了与癌症成人患者菌血症相关的数据，以评估临床特征和结局，并确定死亡率的预测因素。
在 1246 名患者中，896 名（71.9%）患有实体肿瘤，328 名（26.3%）患有血液恶性肿瘤，22 名（1.8%）同时患有这两种疾病。中性粒细胞减少症组比非中性粒细胞减少症组更常见以下情况：医院获得性感染、血液恶性肿瘤、皮质类固醇使用、免疫抑制剂使用、原发性菌血症和肺炎（均 P < 0.05）。感染由革兰氏阴性杆菌引起的占 55.6%，由革兰氏阳性球菌引起的占 32.7%。革兰氏阴性病原体在中性粒细胞减少症患者中比在非中性粒细胞减少症患者中更常被分离出来（61.9% vs. 53.5%，P = 0.010），其中大肠杆菌和肺炎克雷伯菌的比例显著更高。在 1001 名可以评估结局的患者中，总的 30 天死亡率为 24.1%，多因素分析显示金黄色葡萄球菌菌血症是死亡率的一个显著相关因素（比值比（OR），1.80；95%置信区间（CI），1.03-3.15），同时还与医院获得性感染、肺炎、严重脓毒症或感染性休克以及更高的 Pitt 菌血症评分相关（所有 P 值均<0.05）。
本研究代表了对中性粒细胞减少症与非中性粒细胞减少症癌症患者血流感染的全面评估。鉴于金黄色葡萄球菌菌血症在成年癌症患者中的致病性意义，需要制定额外的策略来管理癌症患者的金黄色葡萄球菌菌血症，以改善结局。
