Abstract 39P
Background
Information regarding blood stream infections (BSI) in oncological patients is scarce. We studied retrospectively all admitted oncological patients who presented an episode of BSI.
Methods
Our institution is a 613-bed tertiary teaching hospital in Madrid, with a 20-bed Oncology ward. We recorded retrospectively epidemiological, clinical and microbiological data from all BSI from January 2015 to December 2018. We considered CRB both according to IDSA definition and to CDC definition (CLABSI).
Results
We recorded 124 BSI in 107 patients (33 per 1000 oncological admissions) during the study period. Most of them occurred in patients with cancer at metastatic stage (88%), mainly colorectal cancer (25%) and bilio-pancreatic tumors (19%). Other less frequent etiologies were gynecological tumors (15%), lung cancer and lymphomas (9%). Most of the patients (73,4%) were undergoing chemotherapy at the moment of the BSI, 6.5% targeted therapies and 2.4% immunotherapy; 14% were receiving other treatments such as radiotherapy, hormone therapy or palliative care. Only 10.5% of the patients were neutropenic below 500 neutrophils. BSI was healthcare-associated in 42.7% and hospital-acquired in 46.8%. Catheter was the main source (29%; 46% among patients with central venous line), followed by primary (23%) and intra-abdominal source (22%). Gram negative microorganisms were the most prevalent (34.7%), followed by Staphylococci (29.8%). Among 155 isolated microorganisms, 8.4% were MDR. Complications occurred in 5.6% and 4% required ICU admission. In-hospital mortality was 12%, attributable mortality and 10-day mortality were both 4%. When patients with CRB and non-CRB episodes were compared, the independent differential characteristics were as follows: in CRB patients, the most prevalent microorganisms were gram positive (77.8% vs. 38.6%, OR 5.2, p =0.001), persistence of BSI was more common (33.3% vs. 11.4%, OR 3.2, p =0.032) and so was recurrence (13.9% vs. 1.1%, OR 16.4, p=0.022).
Conclusions
The main source of BSI in admitted oncological patients in our centre is catheter. Patients with CRB present persistent and recurrent bacteremia more often, so to prevent bacteremia and its complications, catheter management should be optimized. Attributable mortality in our study was 4%.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.