Health-care associated bacteremia in geriatric cancer patients with febrile neutropenia.
OBJECTIVE
The aim of this study was to determine the epidemiology, clinical manifestations, and outcome of health-care associated bacteremia in geriatric cancer patients with febrile neutropenia.


METHODS
We retrospectively evaluated cancer patients with febrile neutropenia aged ≥60years with culture proven health-care associated bacteremia between January 2005 and December 2011. The date of the first positive blood culture was regarded as the date of bacteremia onset. Primary outcome was the infection related mortality, defined as the death within 14days of bacteremia onset.


RESULTS
The two most common pathogens responsible for bacteremia were Staphylococcus epidermidis (36.1%) and Escherichia coli (31.5%), with high rates of methicillin resistance and extended-spectrum β-lactamase (ESBL) production, respectively. There were no statistically significant differences in infection related mortality rate according to the type of malignancy (p=0.776). By the univariate analysis, factors associated with 14day mortality among febrile neutropenic episodes were prolonged neutropenia (p=0.024), persistent fever (p=0.001), hospitalization in ICU (p<0.001) and the initial clinical presentations including respiratory failure (p<0.001), hepatic failure (p=0.013), hematological failure (p<0.001), neurological failure (p<0.001), severe sepsis (p<0.001), and septic shock (p=0.036). Multivariate analysis showed that persistent fever was an independent factor associated with infection related mortality (odds ratio, 18.0; 95% confidence interval, 5.2-62.6; p<0.001).


CONCLUSIONS
The only independent risk factor for mortality was persistent fever. Although the most frequently isolated pathogens were S. epidermidis and E. coli, high rates of methicillin resistance and ESBL production were found respectively.
Bulent Ecevit University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, 67600 Zonguldak, Turkey. Electronic address: drhaydemir@yahoo.com.
Hande
H
Aydemir
Nihal
N
Piskin
Furuzan
F
Kokturk
Ayla
A
Gökmen
Deniz
D
Akduman
D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D004926:Escherichia coli; D064147:Febrile Neutropenia / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013212:Staphylococcus epidermidis; D001618:beta-Lactamases / Q000378:metabolism
D001618:beta-Lactamases