title: Factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection.
abstract: The purpose of this study was to identify factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection (BSI). All episodes of BSI occurring in adult neutropenic patients with haematologic malignancies or solid tumours were prospectively recorded from January 2006 to December 2013. We analysed the factors influencing mortality in both groups of patients. We documented 602 consecutive episodes of BSI; 510 occurred in patients with haematologic malignancies and 92 in patients with solid tumours. The overall case-fatality rates were 12% and 36%, respectively. Independent risk factors associated with a higher case-fatality rate in patients with haematologic malignancies were: intensive care unit admission (odds ratio (OR), 15.2; 95% confidence interval (CI), 5.4-42.7), advanced neoplasm (OR, 8.7; 95% CI, 2.9-25.7), corticosteroid therapy (OR, 7.0; 95% CI, 3-16.4), multidrug-resistant Gram-negative BSI (OR, 3.8; 95% CI, 1.2-11.8) and a Multinational Association for Supportive Care in Cancer risk score of <21 (OR, 3.1; 95% CI, 1.3-7.4). By contrast, coagulase-negative staphylococci BSI (OR, 0.04; 95% CI, 0.004-0.5) and empirical antibiotic combination therapy (OR, 0.1; 95% CI, 0.05-0.3) were found to be protective. Independent risk factors for overall case-fatality rate in patients with solid tumours were: shock at presentation (OR, 14.3; 95% CI, 3.2-63.8), corticosteroid therapy (OR, 10; 95% CI, 2.3-44) and advanced neoplasm (OR, 7.8; 95% CI, 1.4-41.4). Prognostic factors identified in this study may help to detect those patients at higher risk of death in each group. Medical intervention addressing some of these factors might improve the outcome of BSI in neutropenic patients with haematologic malignancies or solid tumours.
authors: Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain. Electronic address: mmarin@iconcologia.net.
authors: M
authors: M
authors: Marín
authors: Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain.
authors: C
authors: C
authors: Gudiol
authors: Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, Spain.
authors: C
authors: C
authors: Ardanuy
authors: Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain.
authors: C
authors: C
authors: Garcia-Vidal
authors: Oncology Department, Institut Català d'Oncologia-ICO, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain.
authors: L
authors: L
authors: Jimenez
authors: Hematology Department, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain.
authors: E
authors: E
authors: Domingo-Domenech
authors: Clinical Research Unit, Institut Català d'Oncologia-ICO, IDIBELL, University of Barcelona, Barcelona, Spain.
authors: F J
authors: FJ
authors: Pérez
authors: Infectious Disease Service, IDIBELL, Hospital Universitari de Bellvitge, Spain; Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos IIII, Madrid, Spain.
authors: J
authors: J
authors: Carratalà
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality*; D016019:Survival Analysis; D055815:Young Adult
keywords: Bacteremia; cancer; haematologic malignancy; neutropenia; solid tumour