title: Clinical prognostic factors for time to positivity in cancer patients with bloodstream infections.
abstract: OBJECTIVE
  Time to positivity (TTP) has been used in recent years as a simple and rapid method for the additional characterization of the degree of bacteremia. However, prognostic factors for TTP in cancer patients with bloodstream infections have rarely been studied. The aim of this study was to investigate the clinical factors for TTP involving various isolated organisms in cancer patients.
  
  
  METHODS
  We analyzed 386 episodes of bloodstream infections (BSIs) in patients with or without cancer during a 19 month period. Information on age, gender, tumor type, ICU stay, organisms, multidrug resistance (MDR), TTP and outcome was collected. Multivariate logistic regression analysis was performed.
  
  
  RESULTS
  The mean TTP of Enterobacteriaceae in patients with hepatocellular carcinoma, gastroenterological cancer, and lung cancer was shorter than in non-cancer patients (9.86 ± 3.22, 10.05 ± 3.47, 8.85 ± 2.78 vs 13.11 ± 5.37 h). The mean TTP of nonfermentative bacilli in patients with lung cancer (12.37 ± 5.96 h) and hematologic diseases (8.72 ± 4.21 h) was also shorter than in non-cancer patients (20.74 ± 2.46 h), and the mean TTP of Staphylococcus isolates was significantly different between non-cancer patients (22.06 ± 3.71 h) and hematologic disease patients (11.93 ± 5.44 h). The presence of a benign tumor was a significant prognostic factor for a long TTP only in the Staphylococci group (OR 0.076, 95 % CI 0.014-0.412), according to multivariate analysis. MDR (OR 2.178, 95 % CI 1.196-4.239) was an independent significant predictor in the Enterobacteriaceae group, with a short TTP, and it was also a significant clinical factor for a long TTP in nonfermentative bacilli and the Staphylococci group (OR 5.037, 95 % CI 1.065-23.82; OR 0.167, 95 % CI 0.059-0.474).
  
  
  CONCLUSIONS
  Time to positivity provides useful diagnostic and prognostic information for the differentiation of frequently isolated organisms. This information may help clinicians to use the correct antibiotics in a timely manner to treat cancer patients with BSIs based on clinical factor analysis.
authors.affiliation: Department of Medical Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huan Hu Xi Road, Ti Yuan Bei, He Xi District, Tianjin, 300060, People's Republic of China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Medical Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huan Hu Xi Road, Ti Yuan Bei, He Xi District, Tianjin, 300060, People's Republic of China.
authors.forename: Ding
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Medical Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huan Hu Xi Road, Ti Yuan Bei, He Xi District, Tianjin, 300060, People's Republic of China.
authors.forename: Changsen
authors.initials: C
authors.lastname: Bai
authors.affiliation: Department of Medical Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huan Hu Xi Road, Ti Yuan Bei, He Xi District, Tianjin, 300060, People's Republic of China.
authors.forename: Wenfang
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Medical Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huan Hu Xi Road, Ti Yuan Bei, He Xi District, Tianjin, 300060, People's Republic of China.
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Department of Medical Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huan Hu Xi Road, Ti Yuan Bei, He Xi District, Tianjin, 300060, People's Republic of China. laopang@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Medical Biochemistry and Cell Biology, School of Medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin, 300071, People's Republic of China. sihezhang@nankai.edu.cn.
authors.forename: Sihe
authors.initials: S
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D001419:Bacteria / Q000145:classification; D018407:Bacterial Physiological Phenomena; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000382:microbiology*; D011379:Prognosis; D013997:Time Factors; D055815:Young Adult
keywords: Bloodstream infection; Cancer; Clinical factor; Multidrug resistance; Time to positivity