Prospective Evaluation of Infection Episodes in Cancer Patients in a Tertiary Care Academic Center: Microbiological Features and Risk Factors for Mortality

• Published in: Turkish journal of haematology 2016-12, Vol.33 (4), p.311-319
• Main Authors: Çalık Başaran, Nursel, Karaağaoğlu, Ergun, Hasçelik, Gülşen, Durusu Tanrıöver, Mine, Akova, Murat
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents - therapeutic use; Bacteremia - epidemiology; Bacteremia - etiology; cancer; Cross Infection - drug therapy; Cross Infection - etiology; Cross Infection - microbiology; Cross Infection - mortality; Drug Resistance, Microbial; febrile neutropenia; Febrile Neutropenia - epidemiology; Febrile Neutropenia - etiology; Febrile Neutropenia - microbiology; Female; Hospital Mortality; Humans; Internal Medicine; Male; Middle Aged; mortality; Neoplasms - complications; Prospective Studies; Risk Factors; Tertiary Care Centers; Young Adult
• ISSN: 1300-7777; 1308-5263
• DOI: 10.4274/tjh.2015.0216

We aimed to determine the frequency, type, and etiology of infections and the risk factors for infections and mortality in hospitalized cancer patients. We prospectively enrolled adult cancer patients hospitalized in the internal medicine wards of a tertiary care academic center between January and August 2004. Patients were followed during their hospitalization periods for neutropenia, infections, culture results, and mortality. We followed 473 cancer patients with 818 hospitalization episodes and 384 infection episodes in total. Seventy-nine percent of the infections were nosocomial, and febrile neutropenia (FN) was observed in 196 (51%) of the infection episodes. Bacteremia was found in 29% of FN episodes and in 8% of nonneutropenic patients. Gram-positive bacteria were the leading cause of bacteremia in both neutropenic and nonneutropenic cases (70% and 58%, respectively). Presence of an indwelling central catheter increased bacteremia risk by 3-fold. The overall mortality rate was 17%, whereas 34% of the patients with bloodstream infections died. Presence of bacteremia and advanced disease stage increased overall mortality by 6.1-fold and 3.7-fold, respectively. Nearly half of the cancer patients developed an infection during their hospital stays, with gram-positive bacteria being the predominant etiologic microorganisms. This demonstrates the changing trends in infections considering that, until 2004, gram-negative bacteria were the most predominant microorganisms among cancer patients in our institute.