Epidemiology of bloodstream infections at a cancer center.
BACKGROUND
Cancer patients are at unusually high risk for developing bloodstream infections (BSI), which are a major cause of in-hospital morbidity and mortality.


OBJECTIVE
To describe the epidemiological characteristics and the etiology of BSI in cancer patients.


METHODS
Descriptive study.


METHODS
Terciary Oncology Care Center.


METHODS
During a 24-month period all hospitalized patients with clinically significant BSI were evaluated in relation to several clinical and demographic factors.


RESULTS
The study enrolled 435 episodes of BSI (349 patients). The majority of the episodes occurred among non-neutropenic patients (58.6%) and in those younger than 40 years (58.2%). There was a higher occurrence of unimicrobial infections (74.9%), nosocomial episodes (68.3%) and of those of undetermined origin (52.8%). Central venous catheters (CVC) were present in 63.2% of the episodes. Overall, the commonest isolates from blood in patients with hematology diseases and solid tumors were staphylococci (32% and 34.7%, respectively). There were 70 episodes of fungemia with a predominance of Candida albicans organisms (50.6%). Fungi were identified in 52.5% of persistent BSI and in 91.4% of patients with CVC. Gram-negative bacilli prompted the CVC removal in 45.5% of the episodes. Oxacillin resistance was detected in 26.3% of Staphylococcus aureus isolates and in 61.8% of coagulase-negative Staphylococcus. Vancomycin-resistant enterococci were not observed. Initial empirical antimicrobial therapy was considered appropriate in 60.5% of the cases.


CONCLUSIONS
The identification of the microbiology profile of BSI and the recognition of possible risk factors in high-risk cancer patients may help in planning and conducting more effective infection control and preventive measures, and may also allow further analytical studies for reducing severe infectious complications in such groups of patients.
Velasco
E
E
Control Commission for Hospital Infections, Infectious Diseases Service, Hospital do Câncer, Instituto Nacional do Câncer, Rio de Janeiro, Brazil.
Thuler
L C
LC
Martins
C A
CA
Nucci
M
M
Dias
L M
LM
Gonçalves
V M
VM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology*; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors