title: Bloodstream infections in patients with or without cancer in a large community hospital.
abstract: OBJECTIVE
  Cancer is associated with an increased risk of acquiring bloodstream infection (BSIs). Most knowledge on pathogens and outcome are derived from specialised cancer centres. We here sought to compare causative micro-organisms in BSIs in patients with or without cancer in a 600-bed teaching community hospital.
  
  
  METHODS
  We analysed all positive blood cultures from adult patients between January 2005 and January 2011.
  
  
  RESULTS
  A total of 4,918 episodes of BSI occurred in 2,891 patients, of whom 13.4% had a diagnosis of cancer (85.5% with a solid tumour). In both patient groups, Gram-positive isolates were more prevalent (58.7 and 61.4% in patients with and without cancer, respectively) than Gram-negative isolates (31.8 and 32.3%, respectively). Amongst Gram-positive organisms, coagulase-negative staphylococci, Staphylococcus aureus and enterococci were the most frequently isolated in both patient groups; in cancer patients, twice as many BSIs were caused by Enterococcus faecalis and E. faecium. Amongst Gram-negative organisms, Escherichia coli was the most common isolate; in cancer patients, twice as many BSIs were caused by Pseudomonas aeruginosa and Enterobacter cloacae. Yeasts were grown from 3.0% of blood cultures from cancer patients compared to 1.5% of cultures from non-cancer patients. Cancer patients had a 90-day mortality of 35.8% following BSI compared to 23.5% in patients without cancer.
  
  
  CONCLUSIONS
  These data demonstrate distinct BSI pathogens and impaired outcomes in patients with cancer in the setting of a large community teaching hospital.
authors: Division of Medical Oncology, Department of Internal Medicine, Reinier de Graaf Hospital, Reinier de Graafweg 3-11, 2625 AD, Delft, The Netherlands, bos@rdgg.nl.
authors: M M E M
authors: MM
authors: Bos
authors: L S
authors: LS
authors: Smeets
authors: I
authors: I
authors: Dumay
authors: E
authors: E
authors: de Jonge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002405:Catheterization, Central Venous; D005260:Female; D016469:Fungemia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D006764:Hospitals, Community; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D009426:Netherlands / Q000453:epidemiology; D018709:Statistics, Nonparametric
chemical_list: D000900:Anti-Bacterial Agents
references: Eur J Clin Microbiol Infect Dis. 1996 Apr;15(4):291-6
references: 8781879
references: Arch Med Res. 2000 Jul-Aug;31(4):388-92
references: 11068081
references: Infection. 2010 Feb;38(1):25-32
references: 20012908
references: Intensive Care Med. 2002 Feb;28(2):108-21
references: 11907653
references: N Engl J Med. 2003 Apr 17;348(16):1546-54
references: 12700374
references: Clin Microbiol Infect. 2008 Nov;14(11):1041-7
references: 19040476
references: Crit Care Med. 2004 Apr;32(4):992-7
references: 15071391
references: Am J Med. 1977 May;62(5):731-42
references: 871128
references: JAMA. 1994 May 25;271(20):1598-601
references: 8182812
references: Clin Infect Dis. 2003 May 1;36(9):1103-10
references: 12715303
references: Clin Microbiol Infect. 2004 Jun;10(6):542-9
references: 15191383
references: Crit Care Clin. 2001 Jul;17(3):531-70, vii-viii
references: 11525048
references: N Engl J Med. 1987 Dec 31;317(27):1692-8
references: 2892130
references: Am J Med. 1987 Apr;82(4):723-30
references: 3565430
references: Support Care Cancer. 1998 May;6(3):291-4
references: 9629885
references: J Infect Dis. 2008 Aug 1;198(3):336-43
references: 18522502
references: Infection. 2004 Apr;32(2):65-71
references: 15057569
references: Am J Infect Control. 2008 Dec;36(10):e13-8
references: 19084158
references: JAMA. 2009 Dec 2;302(21):2323-9
references: 19952319
references: Br J Haematol. 1997 Dec;99(3):580-8
references: 9401070
references: Bone Marrow Transplant. 2007 Jun;39(12):775-81
references: 17438585
references: Clin Infect Dis. 2001 Oct 1;33(7):947-53
references: 11528564
references: Am J Med. 2009 Sep;122(9):866-73
references: 19699383
references: N Engl J Med. 1999 Sep 16;341(12):893-900
references: 10486422
references: Int J Antimicrob Agents. 2002 Dec;20(6):412-8
references: 12458134
references: Support Care Cancer. 1997 Jul;5(4):330-3
references: 9257432
references: Eur J Clin Microbiol Infect Dis. 2003 Mar;22(3):137-43
references: 12649710
references: Clin Infect Dis. 2004 Aug 1;39(3):309-17
references: 15306996