Hospital-acquired infections at an oncological intensive care cancer unit: differences between solid and hematological cancer patients.
Cancer patients have a higher risk of severe sepsis in comparison with non-cancer patients, with an increased risk for hospital-acquired infections (HAI), particularly with multidrug resistant bacteria (MDRB). The aim of the study is to describe the frequency and characteristics of HAI and MDRB in critically ill cancer patients.



We conducted an 18-month prospective study in patients admitted ≥48 h to an ICU at a cancer referral center in Mexico. Patients with hematological malignancies (HM) were compared with solid tumors. Demographic and clinical data were recorded. Mortality was evaluated at 30-days.



There were 351 admissions during the study period, among whom 157 (66 %) met the inclusion criteria of the study as follows: 104 patients with solid tumors and 53 with HM. Sixty-four patients (40.7 %) developed 95 episodes of HAI. HAI rate was 4.6/100 patients-days. MDRB were isolated in 38 patients (24 %), with no differences between both groups. Escherichia coli was the main bacteria isolated (n = 24), 78 % were extended spectrum beta-lactamases producers. The only risk factor associated with HAI was the presence of mechanical ventilation for more than 5 days (OR 3.12, 95 % CI 1.6 - 6.2, p = 0.001). At 30-day follow-up, 61 patients (39 %) have died (38 % with solid tumors and 60 % with HM, p < 0.001). No differences were found in mortality at 30-day between patients with HAI (n = 25, 39 %) vs. non-HAI (n = 36, 38.7 %, p = 0.964); neither in those who developed a HAI with MDRB (n = 12, 35.3 %) vs. HAI with non-MDRB (n = 13, 43.3 %, p = 0.51).



Patients with cancer who are admitted to an ICU, have a high risk of HAI, but there were no differences patients with solid or hematologic malignancies.
Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico. patcornejo@yahoo.com.
Patricia
P
Cornejo-Juárez
Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico.
Diana
D
Vilar-Compte
Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico.
Alejandro
A
García-Horton
Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico.
Marco
M
López-Velázquez
Department of Critical Care Medicine, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico.
Silvio
S
Ñamendys-Silva
Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico.
Patricia
P
Volkow-Fernández
D000150:Acinetobacter; D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003422:Critical Care; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D016984:Enterococcus faecium / Q000302:isolation & purification / Q000502:physiology; D004926:Escherichia coli / Q000302:isolation & purification / Q000502:physiology; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007362:Intensive Care Units; D007709:Klebsiella / Q000302:isolation & purification / Q000502:physiology; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology; D016522:Oncology Service, Hospital; D010198:Pancytopenia / Q000453:epidemiology; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D065507:Vancomycin-Resistant Enterococci
D000970:Antineoplastic Agents
Hospital-acquired infections; Intensive care unit; Mortality; Multidrug resistance bacteria