Ture Zeynep, İskender Gülşen, Serhat Şahinoğlu Mustafa, Beste Özkara Ezel, Kalem Ayşe Kaya, Eryılmaz Eren Esma, Ürkmez Fatma Yekta, Çetin Sinan, Azak Emel, Erdem İlknur, Rello Jordi, Alp Emine
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, , Türkiye.
University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital. Infectious Diseases and Clinical Microbiology Clinic, Ankara, Türkiye.
Am J Med Sci. 2025 Jun;369(6):679-688. doi: 10.1016/j.amjms.2025.02.008. Epub 2025 Feb 12.
To determine the epidemiology and prognosis of sepsis in cancer patients and the influence of sepsis on the mortality of cancer patients.
In this multicenter, prospective, observational study, cancer patients hospitalized without sepsis followed up until discharge or a maximum of 90 days were included. The incidence of sepsis in the follow-up period, risk factors for sepsis, risk factors for 28-day mortality in patients with sepsis and 90-day mortality in the entire group were determined.
During the study, 790 cancer patients were included. Sepsis developed in 72 patients (9.1 %) during the follow-up. Older age, hospitalization due to any infection, graft versus host diseases (GVHD), the presence of a urethral catheter, and previous bacterial infection in the last three months were risk factors of sepsis. Among all cancer patients, sepsis was found to be the most important factor influencing 90-day mortality (OR 13.42(1.79-6.83)). Mortality among the sepsis cohort was independently associated with an infection with a carbapenem-resistant bacterium (OR 15.47(1.45-64.17)), appropriateness of empirical treatment (OR 5.02 (0.17-7.61)) and having a clinical improvement on the fifth day of the treatment (OR 10.58(0.39-28.25)).
Sepsis was documented in one out of 11 hospitalized cancer patients and the mortality rate increases 13-fold when sepsis develops. Invasive devices, GVHD, and previous bacterial infections were related to sepsis and antibiotic resistance were the most important driver for mortality. Antimicrobial stewardship, rational use of catheters (if necessary, in accordance with asepsis/antisepsis, short-term use) is important to save lives in cancer patients.
确定癌症患者脓毒症的流行病学特征和预后，以及脓毒症对癌症患者死亡率的影响。
在这项多中心、前瞻性观察研究中，纳入了无脓毒症住院的癌症患者，随访至出院或最长90天。确定随访期间脓毒症的发生率、脓毒症的危险因素、脓毒症患者28天死亡率和全组90天死亡率的危险因素。
研究期间纳入790例癌症患者。随访期间72例患者（9.1%）发生脓毒症。年龄较大、因任何感染住院、移植物抗宿主病（GVHD）、存在尿道导管以及过去三个月内有细菌感染是脓毒症的危险因素。在所有癌症患者中，脓毒症被发现是影响90天死亡率的最重要因素（比值比13.42（1.79 - 6.83））。脓毒症队列中的死亡率与耐碳青霉烯类细菌感染（比值比15.47（1.45 - 64.17））、经验性治疗的恰当性（比值比5.02（0.17 - 7.61））以及治疗第5天有临床改善（比值比10.58（0.39 - 28.25））独立相关。
11例住院癌症患者中有1例发生脓毒症，脓毒症发生时死亡率增加13倍。侵入性装置、GVHD和既往细菌感染与脓毒症相关，抗生素耐药是死亡率的最重要驱动因素。抗菌药物管理、合理使用导管（如有必要，遵循无菌/防腐原则，短期使用）对挽救癌症患者生命很重要。
