Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer : Differences between Patients with Hematological Malignancies and Solid Tumors
Royo-Cebrecos, Cristina (Hospital Nostra Senyora de Meritxell (Principat d'Andorra))
Laporte-Amargós, Júlia (Hospital Universitari de Bellvitge)
Peña, Marta (Hospital Universitari de Bellvitge)
Ruiz-Camps, Isabel (Hospital Universitari Vall d'Hebron)
Puerta-Alcalde, Pedro (Hospital Clínic i Provincial de Barcelona)
Abdala, Edson (Univesity of São Paulo)
Oltolini, Chiara (IRCCS San Raffaele Scientific Institute (Milà, Itàlia))
Akova, Murat (Hacettepe University School of Medicine)
Montejo, Miguel (Hospital Universitario de Cruces (Barakaldo, País Basc))
Mikulska, Malgorzata (University of Genoa (DISSAL) and Ospedale Policlinico San Martino)
Martín-Dávila, Pilar (Hospital Universitario Ramón y Cajal (Madrid))
Herrera, Fabian (Centro de Educación Médica e Investigaciones Clínicas)
Gasch Blasi, Oriol (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Drgona, Lubos (Comenius University and National Cancer Institute)
Morales, Hugo Manuel Paz (Hospital Erasto Gaertner)
Brunel, Anne-Sophie (Lausanne University Hospital)
García, Estefanía (Hospital Universitario Reina Sofía (Córdoba, Espanya))
Isler, Burcu (Istanbul Education and Research Hospital)
Kern, Winfried V. (University of Freiburg Medical Center and Faculty of Medicine)
Palacios-Baena, Zaira R. (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
de la Calle, Guillermo Maestro (Instituto de Investigación Hospital "12 de Octubre" (i+12))
Montero, María Milagro (Institut Hospital del Mar d'Investigacions Mèdiques)
Kanj, Souha S. (American University of Beirut Medical Center)
Sipahi, Oguz R. (Ege University)
Calik, Sebnem (University of Health Science Izmir Bozyaka Training and Research Hospital)
Márquez-Gómez, Ignacio (Hospital Regional Universitario de Málaga)
Marin, Jorge I. (Clínica Maraya)
Gomes, Marisa Z. R. (Hospital Federal dos Servidores do Estado)
Hemmatti, Philipp (Charité University Medical School)
Araos, Rafael (Instituto de Ciencias e Innovación en Medicina)
Peghin, Maddalena (University of Udine and Azienda Sanitaria Universitaria Integrata in Udine)
Del Pozo, Jose Luis (Clínica Universitaria Navarra)
Yáñez, Lucrecia (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Tilley, Robert (University Hospitals Plymouth NHS Trust (Regne Unit))
Manzur, Adriana (Hospital Rawson)
Novo, Andrés (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Carratalà, Jordi (Hospital Universitari de Bellvitge)
Gudiol, Carlota (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Data:	2022
Resum:	To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006-May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0. 1 × 10 9 cells/mm) (67% vs. 44. 6%; p < 0. 001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32. 2% vs. 26. 7%; p = 0. 05). Catheter-infection (10. 7% vs. 4. 7%; p = 0. 001), mucositis (2. 4% vs. 0. 7%; p = 0. 042), and perianal infection (3. 6% vs. 0. 3%; p = 0. 001) predominated as BSI sources in the hematological patients, whereas pneumonia (22. 9% vs. 33. 7%; p < 0. 001) and other abdominal sites (2. 8% vs. 6. 3%; p = 0. 006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23. 2% vs. 7. 7%; p < 0. 001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20. 1% vs. 12%; p < 0. 001). Patients with ST presented more frequently with septic shock (45. 8% vs. 30%; p < 0. 001), and presented worse outcomes, with increased 7-day (38% vs. 24. 2%; p < 0. 001) and 30-day (49% vs. 37. 3%; p < 0. 001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Bacteremia ; Bloodstream infection ; Cancer ; Hematologic malignancy ; Pseudomonas aeruginosa ; Solid tumor
Publicat a:	Pathogens, Vol. 11 (september 2022) , ISSN 2076-0817

DOI: 10.3390/pathogens11101132
PMID: 36297188

12 p, 295.7 KB

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