title: Clinical features, aetiology and outcome of bacteraemic pneumonia in neutropenic cancer patients.
abstract: We aimed to assess the clinical features, aetiology and outcomes of bacteraemic pneumonia in neutropenic cancer patients (NCP) in the current era of increasing antimicrobial resistance.
  
  
  
  All episodes of bacteraemia occurring in hospitalized patients with cancer, including haematopoietic stem cell transplant recipients, from January 2006 to April 2015 were included.
  
  
  
  We identified 1723 episodes of bacteraemia, of which 795 occurred in neutropenic patients with cancer, and among them, 55 episodes were identified as bacteraemic pneumonia. The most frequent causative agents were Pseudomonas aeruginosa (39.6%), Streptococcus pneumoniae (20.6%) and Escherichia coli (8.6%). Among the Gram-negative organisms, 12.8% were multidrug resistant (MDR). Eleven patients (20%) required admission to intensive care, and eight (14.8%) underwent invasive mechanical ventilation. Nine patients (16.3%) received inadequate empirical antibiotic therapy, of whom six (66.6%) died; eight of these nine patients had pneumonia caused by resistant microorganisms. The early (48 h) case-fatality rate was 24% and the overall (30 day) case-fatality rate was 46.2%.
  
  
  
  Bacteraemic pneumonia is a frequent complication among NCP and is mainly caused by P. aeruginosa and S. pneumoniae. The emergence of MDR organisms is of special concern. Despite the improvement in the management of cancer patients, case-fatality rates of NCP with bacteraemic pneumonia remain high. Urgent assessment is needed to identify a better approach for the management and support of these patients.
authors.affiliation: Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. cgudiol@iconcologia.net.|Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. cgudiol@iconcologia.net.|Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. cgudiol@iconcologia.net.|REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain. cgudiol@iconcologia.net.
authors.forename: Carlota
authors.initials: C
authors.lastname: Gudiol
authors.affiliation: Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Royo-Cebrecos
authors.affiliation: Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Júlia
authors.initials: J
authors.lastname: Laporte
authors.affiliation: Departments of Microbiology of Bellvitge Univesity Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|CIBERes (CIBEr Respiratory Diseases), ISCIII, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ardanuy
authors.affiliation: Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Garcia-Vidal
authors.affiliation: Departments of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Antonio
authors.affiliation: Departments of Haematology Duran i Reynals Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Arnan
authors.affiliation: Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.|REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009369:Neoplasms / Q000097:blood / Q000150:complications; D009503:Neutropenia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
keywords: bacteraemic pneumonia; bloodstream infection; cancer; neutropenia; pneumonia