Factors associated with mortality in bacteremic patients with hematologic malignancies.
We conducted a retrospective cohort study to identify risk factors for mortality in a large cohort of hematologic patients with bacteremia. From 2000 through 2005, bacteremia was diagnosed in 217 patients with hematologic malignancies. The infections were caused only by Gram-positive organisms in 57.1% (124/217) cases and only by Gram-negative bacteria in 37.8% (82/217); the remaining 5.1% (11/217) were polymicrobial. The overall 30-day mortality rate was 20.3% (44/217). In multivariate analysis, significant predictors of mortality were prolonged neutropenia (P < 0.001), acute renal failure (P = 0.002), nosocomial bacteremia (P = 0.009), age >55 years (P = 0.007), and monomicrobial bacteremia due to antibiotic-resistant Gram-negative bacteria (P = 0.009). Reducing fatal outcomes associated with bacteremia in patients with hematologic malignancies is a challenge, and the emergence of resistance to the antimicrobials widely used in this setting is of great concern. Future infection trends must be carefully monitored and treatment guidelines adjusted accordingly.
Tumbarello
Mario
M
Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy. tumbarello@rm.unicatt.it
Spanu
Teresa
T
Caira
Morena
M
Trecarichi
Enrico M
EM
Laurenti
Luca
L
Montuori
Eva
E
Fianchi
Luana
L
Leone
Fiammetta
F
Fadda
Giovanni
G
Cauda
Roberto
R
Pagano
Livio
L
D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors