title: Bloodstream infections in adult patients with cancer: clinical features and pathogenic significance of Staphylococcus aureus bacteremia.
abstract: OBJECTIVE
  The aim of this study was to more precisely delineate the characteristics and outcomes of bloodstream infections in adult cancer patients.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Joon-Sup
authors.initials: JS
authors.lastname: Yeom
authors.forename: Jun Seong
authors.initials: JS
authors.lastname: Son
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Wi
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality / Q000503:physiopathology; D001419:Bacteria / Q000145:classification; D003428:Cross Infection / Q000097:blood / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000382:microbiology*; D011159:Population Surveillance; D056910:Republic of Korea; D013203:Staphylococcal Infections / Q000097:blood*; D013211:Staphylococcus aureus