Sources and outcome of bloodstream infections in cancer patients : the role of central venous catheters

• Published in: European journal of clinical microbiology & infectious diseases 2007-08, Vol.26 (8), p.549-556
• Main Authors: RAAD, I, HACHEM, R, HANNA, H, BAHNA, P, CHATZINIKOLAOU, I, FANG, X, JIANG, Y, CHEMALY, R. F, ROLSTON, K
• Format: Article
• Language: English
• Subjects: Aged; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Blood; Catheterization, Central Venous - adverse effects; Catheters; Critical Illness; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - microbiology; Female; Gram-Negative Bacterial Infections - complications; Gram-Negative Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - complications; Gram-Positive Bacterial Infections - epidemiology; Hematologic and hematopoietic diseases; Hospitals, University; Human bacterial diseases; Humans; Incidence; Infectious diseases; Male; Medical instruments; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Multivariate analysis; Neoplasms - blood; Neoplasms - complications; Neutropenia; Other diseases. Hematologic involvement in other diseases; Prognosis; Tumors
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-007-0320-6

Simultaneously drawn quantitative blood cultures are used to diagnose catheter-related bloodstream infections. We conducted this study to determine the frequency with which central venous catheters were the source of bloodstream infections detected through paired positive blood cultures drawn from cancer patients and the potential for quantitative blood cultures to help predict outcome in neutropenic and non-neutropenic patients. From September 1999 to November 2000, we identified 169 patients with bloodstream infections. Of all bloodstream infections, 56% were catheter-related bloodstream infections. Gram-positive bacteremia was found to be catheter-related in 55% and 69% of patients with hematologic malignancy and solid tumors, respectively, whereas gram-negative bacteremia was catheter-related in only 19% of patients with underlying hematologic malignancy and in 60% of patients with solid tumor (P = 0.01). By multivariate analysis, poor response was associated with critical illness and persistent neutropenia (P < 0.01). In neutropenic patients with catheter-related bloodstream infections, peripheral quantitative blood cultures of >or=100 CFU/mL was also associated with poor response (P = 0.05). Central venous catheters were the major source of bloodstream infection, particularly in patients with solid tumors. In addition to critical illness and persistent neutropenia, quantitative blood cultures might be useful in predicting outcomes for neutropenic patients with catheter-related bloodstream infections.