title: Bloodstream infections and mortality-related factors in febrile neutropenic cancer patients.
abstract: BACKGROUND
  We performed a prospective observational cohort study to evaluate the causative bacteria and to identify risk factors for mortality in febrile neutropenic (FN) patients with blood stream infection (BSI).
  
  
  METHODS
  We conducted a prospective data collection on all patients with bacteremia or fungemia. The patients were assigned into low-risk and high-risk groups in accordance with the Multinational Association for Supportive Care in Cancer (MASCC) Risk Index.
  
  
  RESULTS
  Throughout the study period, the patients developed 420 FN episodes. Out of 420 episodes, only 90 (21.4%) were found to have bloodstream infection. The mean age of the patients was 45.6±18.4 years and 55.6% of the patients were male. A total of 98 isolates were recovered from the cases of BSI. Coagulase-negative Staphylococcus spp (CoNS) were the most common isolates overall (33.7%). There was a significant increase in the rate of gram-negative bacteria throughout the study period (p=0.028). Overall mortality was 33%. Multivariate analyses showed that MASCC risk scores (p=0.0001, OR=15.1, CI%95 4.5-50.7), ICU wards (p=0.0002, OR= 8.6, Cl%95 1.101-68,157) and CoNS (p=0.004, OR=12.12, CI%95 2.3-64.7) were independent risk factors associated with mortality. BSI due to CoNS was associated with lower mortality; however, MASCC high risk score and ICU stay were associated with higher mortality.
  
  
  CONCLUSIONS
  The MASCC risk-index score and emergence of CoNS in positive blood cultures are valuable tools in the management of FN.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Mersin University, Faculty of Medicine, Mersin, Turkey. sahinelif@gmail.com
authors.forename: Elif Sahin
authors.initials: ES
authors.lastname: Horasan
authors.forename: Gulden
authors.initials: G
authors.lastname: Ersoz
authors.forename: Anil
authors.initials: A
authors.lastname: Tombak
authors.forename: Naci
authors.initials: N
authors.lastname: Tiftik
authors.forename: Ali
authors.initials: A
authors.lastname: Kaya
mesh_terms: D016470:Bacteremia / Q000150:complications* / Q000382:microbiology; D005260:Female; D005334:Fever / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D006090:Gram-Negative Bacteria / Q000502:physiology; D006094:Gram-Positive Bacteria / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D009503:Neutropenia / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D012307:Risk Factors