Bloodstream infection caused by S. aureus in patients with cancer: a 10-year longitudinal single-center study

• Published in: Supportive care in cancer 2018-12, Vol.26 (12), p.4057-4065
• Main Authors: Bello-Chavolla, Omar Yaxmehen, Bahena-Lopez, Jessica Paola, Garciadiego-Fosass, Pamela, Volkow, Patricia, Garcia-Horton, Alejandro, Velazquez-Acosta, Consuelo, Vilar-Compte, Diana
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia - etiology; Bacteremia - microbiology; Blood cancer; Blood tests; Cancer; Cancer patients; Cancer research; Care and treatment; Comparative analysis; Cross infection; Epidemiology; Female; Health aspects; Humans; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neoplasms - complications; Nosocomial infections; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Pneumonia; Rehabilitation Medicine; Risk assessment; Risk Factors; Staphylococcal Infections - complications; Staphylococcal Infections - microbiology; Staphylococcus aureus; Staphylococcus aureus infections; Staphylococcus infections; Time Factors; Type 2 diabetes; Young Adult
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-018-4275-1

Background Staphylococcus aureus bloodstream infections (SABIs) represent a significant cause of morbidity and mortality in cancer patients. In this study, we compared infection characteristics and evaluated epidemiology and risk factors associated to SABIs and 30-day attributable mortality in cancer patients. Methods Clinical and microbiological data from patients with cancer and positive blood cultures for S. aureus were retrieved during a 10-year period at an oncology reference center. Analyses were performed according to type of malignancy and infection with methicillin-resistant S. aureus (MRSA). Data was evaluated using competing risk analyses to identify risk factors associated to 30-day mortality and used to create a point system for mortality risk stratification. Results We included 450 patients and MRSA was documented in 21.1%. Hospital-acquired infection, healthcare-associated pneumonia, and type-2 diabetes were associated to MRSA. In patients with hematologic malignancies, MRSA was more frequent if hospital-acquired, but less likely in primary bacteremia. Variables associated to mortality included abdominal source of infection, hematologic malignancy, MRSA, glucose levels > 140 mg/dL, and infectious endocarditis; catheter removal and initiation of adequate treatment within 48 h of positive blood culture were protective factors. From our designed mortality prediction scale, patients with a score > 3 had a 70.23% (95%CI 47.2–85.3%) probability of infection-related death at 30 days. Conclusion SABIs are a significant health burden for cancer patients. Risk factors for SABI-related mortality in this population are varied and impose a challenge for management to improve patient’s outcomes. Risk stratification might be useful to evaluate 30-day mortality risk.