Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database

• Published in: British journal of cancer 2021-08, Vol.125 (3), p.458-464
• Main Authors: Jensen, Kristian Hastoft, Vogelius, Ivan, Moser, Claus Ernst, Andersen, Elo, Eriksen, Jesper Grau, Johansen, Jørgen, Farhadi, Mohammad, Andersen, Maria, Overgaard, Jens, Friborg, Jeppe
• Format: Article
• Language: English
• Subjects: 692/4028/67/1536; 692/4028/67/2324; Aged; Biomedical and Life Sciences; Biomedicine; Cancer Research; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Databases, Factual; Denmark - epidemiology; Disseminated infection; Drug Resistance; Epidemiology; Female; Head & neck cancer; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - virology; Human papillomavirus; Humans; Larynx; Male; Middle Aged; Molecular Medicine; Mortality; Mucositis; Oncology; Oral cavity; Oropharyngeal cancer; Papillomavirus Infections - epidemiology; Patients; Pharynx; Population studies; Population-based studies; Prognosis; Radiation therapy; Radiotherapy - adverse effects; Registries; Risk Factors; Sepsis - epidemiology; Sepsis - microbiology; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - drug therapy; Squamous Cell Carcinoma of Head and Neck - radiotherapy; Squamous Cell Carcinoma of Head and Neck - virology; Staphylococcus aureus; Staphylococcus aureus - classification; Staphylococcus aureus - isolation & purification; Survival Analysis; Throat cancer
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-021-01430-w

Background Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy (RT) or chemoradiation (CRT) may become immunocompromised. In this population-based study, we aimed to investigate the risk factors, microbiological aetiologies, prognosis and impact on early non-cancer mortality of bloodstream infections (BSIs) after RT/CRT. Methods Patients with HNSCC of the pharynx, larynx and oral cavity treated with curative-intent RT/CRT in Denmark between 2010 and 2017 and subsequent BSI episodes occurring within 18 months of RT/CRT initiation were identified in national registries. Results We included 5674 patients and observed 238 BSIs. Increasing age, stage and performance status were significantly associated with an elevated BSI risk, while sex, smoking and high-grade mucositis were not. Human papillomavirus-positive oropharyngeal cancer patients had a decreased risk. Staphylococcus aureus accounted for 34% of episodes occurring during the first 3 months. The 30-day post-BSI mortality rate was 26% (95% confidence interval: 19–32) and BSIs were involved in 10% of early non-cancer deaths. Conclusion The risk of BSI development is associated with several patient- and disease-related factors and BSIs contribute considerably to early non-cancer mortality. Empiric antibiotic treatment regimens should prioritise coverage for S. aureus when treating suspected systemic infection in this population.