title: Epidemiology of bloodstream infections in patients with myeloma receiving current era therapy.
abstract: BACKGROUND
  Bloodstream infections (BSIs) are a significant complication of treatment for multiple myeloma (MM). The objective of this study was to define the epidemiology of BSI with current era MM treatment regimens, including immunomodulatory drugs, proteasome inhibitors and autologous haematopoietic stem cell transplantation (ASCT).
  
  
  METHODS
  Clinical and microbiology records of patients with MM diagnosed between 2008 and 2012 were reviewed using a standardised tool to capture patient demographics, myeloma characteristics and BSI characteristics (type, severity, outcomes). Conditional risk set modelling was used to determine clinical predictors of BSI.
  
  
  RESULTS
  Of 199 studied patients, 71 (35.6%) had confirmed BSI (98 infection episodes). Peak incidence was 65.1 infections/100 patient-years at 4-6 months following MM diagnosis with a late peak at 64-66 months. Gram-positive pathogens were responsible for the majority (54.5%) of infections during induction, whilst gram-negative pathogens were responsible for the majority (57.7%) of infections during disease progression. Overall, Escherichia coli was the most frequently identified pathogen. Streptococcus pneumoniae comprised 6.1% of all BSIs at a median of 7.5 months following MM diagnosis. Highest rates of ICU admission (23.1%) and mortality (11.5%) were seen with BSIs in patients with progressive disease. Recent ASCT was independently associated with increased BSI risk (HR 3.09, P = 0.05).
  
  
  CONCLUSIONS
  Treatment of progressive disease is a high-risk period for infection, evidenced by high proportions of BSI due to gram-negative pathogens and S. pneumoniae. Targeted evaluation of preventative strategies (prophylaxis, vaccination) to reduce morbidity and mortality during this period is required.
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.|Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Teh
authors.affiliation: Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.|Department of Haematology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Harrison
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.|Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.|Victorian Infectious Diseases Service, Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.|Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012306:Risk; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*
keywords: bloodstream infection; epidemiology; myeloma; risk