2335. Clinical Features, Etiology, and Outcome of Bacteremic Pneumonia in Cancer Patients.
Session: Poster Abstract Session: Infections in the Compromised Host
Saturday, October 29, 2016
Room: Poster Hall
Background: Current information regarding bacteremic pneumonia (BP) in cancer pts is scarce. We saught to analyze the clinical features, etiology, and outcomes of BP in this population.

Methods: All consecutive episodes of bacteremia in hospitalized adult cancer pts and hematopoietic stem cell transplant recipients (HSCT) were prospectively collected (Jan 2006 - Mar 2016). BP was defined as the presence of an acute respiratory illness and a pulmonary infiltrate on a chest radiograph in association with positive blood cultures.

Results: Of 1977 episodes of bacteremia in cancer pts, 154 (7.8%) were identified as BP. Seventy-nine (51.3%) pts had solid tumor and 20 (12.3%) were HCST recipients. Fourty-nine (31.8%) pts had neutropenia, and 56% had chronic advanced malignancy. Previous corticosteroids were observed in 47% of pts. The most frequent causative agent was Streptococcus pneumoniae (52.5%), followed by Pseudomonas aeruginosa (18.9%), and Haemophilus inflluenzae (6.3%). Among all Gram-negatives, 6 (10%) isolates were multidrug-resistant. Thirty-eight (24.7%) pts presented with septic shock, 18 (11.7%) required intensive care unit admission, and 9 (16.7%) underwent mechanical ventilation. Overall, 12 pts (7.8%) received inadequate empirical antibiotic therapy, of whom 9 (18.8%) pts died. 30-day and 48-hour case-fatality rates were 31.6% and 14.9%, respectively. Independent risk factors for 30-day case-fatality were chronic advanced malignancy (OR 3.3, 95% CI 1.1-9.9; p=0.026), corticosteroids (OR 3.3, 95% CI 1.2-9.2; p=0.017), and inadequate initial empirical antibiotic therapy (OR 6.6, 95% CI 1.2-35.5; p=0.027). Independent risk factors for 48-hour case-fatality were infection due to P. aerugionosa (OR 9.0, 95% CI 1.5-52.9; p=0.015) and Escherichia coli(OR 14.7, 95% CI 1.5-141.4; p=0.019), and inadequate initial empirical antibiotic therapy (OR 20.3, 95% CI 3.0-136.4; p=0.002).

Conclusion: BP in cancer pts is mainly caused by S. pneumoniae and P. aeruginosa. The emergence of antimicrobial resistance is of special concern. Case-fatality rates among pts with BP remain high, especially in pts with chronic advanced disease, with infection due to Gram-negatives, and in those who receive inadequate initial empirical antibiotic therapy.

Carlota Gudiol, MD PhD1,2,3,4, Cristina Royo-Cebrecos, MD1,2, Santi Mercadal, MD5, Mariona Calvo, MD6 and Jordi CarratalĂ , Professor1,2,3, (1)Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain, (2)Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain, (3)IDIBELL, L'Hospitalet de Llobregat, Spain, (4)Hospital Duran i Reynals-ICO, L'Hospitalet de Llobregat, Spain, (5)Hematology, Hospital Duran i Reynals-ICO, L'Hospitalet de Llobregat, Spain, (6)Oncology, Hospital Duran i Reynals-ICO, L'Hospitalet de Llobregat, Spain

Disclosures:

C. Gudiol, None

C. Royo-Cebrecos, None

S. Mercadal, None

M. Calvo, None

J. CarratalĂ , 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.