Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors

Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, re...

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Autores: Royo-Cebrecos, Cristina, Montero, Maria Milagro, IRONIC study group
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/56683
Acceso en línea:http://hdl.handle.net/10230/56683
http://dx.doi.org/10.3390/pathogens11101132
Access Level:acceso abierto
Palabra clave:Pseudomonas aeruginosa
Bacteremia
Bloodstream infection
Cancer
Hematologic malignancy
Solid tumor
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spelling Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumorsRoyo-Cebrecos, CristinaMontero, Maria MilagroIRONIC study groupPseudomonas aeruginosaBacteremiaBloodstream infectionCancerHematologic malignancySolid tumorObjectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006−May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.MDPI202320232022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/56683http://dx.doi.org/10.3390/pathogens11101132reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésPathogens. 2022 Sep 30;11(10):1132© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/566832026-06-12T07:21:37Z
dc.title.none.fl_str_mv Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
title Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
spellingShingle Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
Royo-Cebrecos, Cristina
Pseudomonas aeruginosa
Bacteremia
Bloodstream infection
Cancer
Hematologic malignancy
Solid tumor
title_short Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
title_full Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
title_fullStr Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
title_full_unstemmed Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
title_sort Pseudomonas aeruginosa bloodstream infections in patients with cancer: Differences between patients with hematological malignancies and solid tumors
dc.creator.none.fl_str_mv Royo-Cebrecos, Cristina
Montero, Maria Milagro
IRONIC study group
author Royo-Cebrecos, Cristina
author_facet Royo-Cebrecos, Cristina
Montero, Maria Milagro
IRONIC study group
author_role author
author2 Montero, Maria Milagro
IRONIC study group
author2_role author
author
dc.subject.none.fl_str_mv Pseudomonas aeruginosa
Bacteremia
Bloodstream infection
Cancer
Hematologic malignancy
Solid tumor
topic Pseudomonas aeruginosa
Bacteremia
Bloodstream infection
Cancer
Hematologic malignancy
Solid tumor
description Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006−May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.
publishDate 2022
dc.date.none.fl_str_mv 2022
2023
2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/56683
http://dx.doi.org/10.3390/pathogens11101132
url http://hdl.handle.net/10230/56683
http://dx.doi.org/10.3390/pathogens11101132
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Pathogens. 2022 Sep 30;11(10):1132
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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