2309. Bacteremia in Cancer Patients. Comparison between Solid and Hematological Tumors and Impact on 30-day Mortality
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Solid Organ Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Poster ID Week 2016.pdf (479.9 kB)
  • Background: The characteristics and outcomes of bacteremia in cancer patients can be different depending if the underlying disease is a solid tumor (ST) or a hematological tumor (HT). The objective of this study is to compare the characteristics and outcomes of episodes of bacteremia in these patients according to their underlying disease.

    Methods: Prospective, multicenter study. Episodes of bacteremia in adult patients with cancer were included in 10 centers in Argentina, from July 2014 to January 2016. The 30-day mortality was examined by the Kaplan-Meier method with the log-rank test and the Cox regression model was used to test statistical significance.

    Results: 370 episodes of bacteremia were included, 291 (78.6%) had HT and 79 (21.4%) ST. Gram Negative Rods (GNR) were isolated in 246 episodes (66.5%), being Escherichia coli (21.4%) and Klebsiella spp. (21.1%) the most frequent. In 137 (37%) Gram Positive Cocci (GPC) were identified, being Staphylococcus aureus (11.4%) and Coagulase-negative staphylococci (CoNS) (10,8%) the most common. Multidrug-resistant bacteria (MDRB) were isolated in 166 episodes (44.9%), being the most frequent extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (13.5%). ST group had higher Charlson scores (median) (6 vs 2, p=0.0001), higher PITT scores (median) (1 vs 0, p=0.015) and more GPC bacteremia (46.8 vs 34.4%, p=0.04). HT group had more MDRB bacteremia (51.2 vs 21.5%, p=0.001), especially ESBL-producing Enterobacteriaceae (15.5 vs 6.3%, p=0.035) and were more frequently neutropenic (68 vs 27.8%, p=0.0001). APACHE II scores were similar in both groups (median) (ST: 13 vs HT:12, p=0.59). Frequency of adequate empirical treatment was similar (82,3 vs 74,9%, p=0.17), although empirical carbapenem use was more frequent in HT group (43.3%  vs 19, p=0.0001). 30-day mortality was higher in ST group (31.6 vs 19.6%, p=0.017) (Kaplan-Meier, Figure 1). However, in multivariate analysis risk factors for 30-day mortality were a high Charlson score (>4) (HR=2,06, IC95% 1.04-4,1, p=0.03), a high APACHE II score (>24) (HR=2,69, IC95% 1.37-5.27, p=0.004), a high PITT score (>4) (HR=4,25, IC95% 2.3-7.9, p=0.001) and having a MDRB bacteremia (HR=2.15, IC95% 1.2-3.7, p=0.006).

    Conclusion: Patients with ST and bacteremia had a higher risk of death compared to HT, secondary to more comorbidites and more severe infections, even though HT patients had more MDRB bacteremia.

    Figure 1.jpg

    Alberto Carena, MD1, Ana Laborde, MD2, Inés Roccia Rossi, MD3, Graciela Guerrini, MD4, Alejandra Valledor, Infectious Diseases Specialist5, Rosana Jordán, MD6, Andrea Nenna, MD7, Patricia Costantini, MD8, Miguel Dictar, MD9, Juan Pablo Caeiro, MD10, María Luz González Ibañez, MD2, Pilar Vizcarra, MD3, Cynthia Jimena Palacios, MD4, Victoria Pinoni, MD6, Martín Luck, MD8, Agustina Racioppi, MD9, Fabián Herrera, MD1 and Argentinean Bacteremia in Cancer and SCT Study Group, (1)Infectious Diseases, Centro de Educación Médica e Investigaciones Clí­nicas, CEMIC, Buenos Aires, Argentina, (2)FUNDALEU, Buenos Aires, Argentina, (3)Hospital HIGA Gral. San Martín, La Plata, Argentina, (4)Hospital HIGA Dr. Rodolfo Rossi, La Plata, Argentina, (5)Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, (6)Hospital Británico de Buenos Aires, Buenos Aires, Argentina, (7)Hospital Municipal de Oncología Marie Curie, Buenos Aires, Argentina, (8)Instituto de Oncología Angel H. Roffo, Buenos Aires, Argentina, (9)Instituto Alexander Fleming, Buenos Aires, Argentina, (10)Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina

    Disclosures:

    A. Carena, None

    A. Laborde, None

    I. Roccia Rossi, None

    G. Guerrini, None

    A. Valledor, None

    R. Jordán, None

    A. Nenna, None

    P. Costantini, None

    M. Dictar, None

    J. P. Caeiro, None

    M. L. González Ibañez, None

    P. Vizcarra, None

    C. J. Palacios, None

    V. Pinoni, None

    M. Luck, None

    A. Racioppi, None

    F. Herrera, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.