Polymicrobial Bloodstream Infections in Cancer Patients: Incidence, Risk Factors, and Outcomes

What is it about?

This study investigates the incidence, clinical features, risk factors, aetiology, antimicrobial resistance, and outcomes of polymicrobial bloodstream infections (PBSI) in patients with cancer. A total of 194 episodes of PBSI were compared with 1702 episodes of monomicrobial bloodstream infections (MBSI) between 2006 and 2015. The study found that PBSI was more frequent in patients with cancer, particularly those with cholangitis, biliary stenting, or neutropenia. Enterococcus spp. were a significant cause of PBSI, and multidrug-resistant (MDR) organisms were more commonly found in PBSI than in MBSI. The study also identified high-risk MASCC index score, corticosteroid use, persistent bacteraemia, and septic shock as risk factors for overall case-fatality. PBSI incidence is increasing in patients with cancer, and physicians should be aware of the risk factors to provide effective antibiotic therapy.

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Why is it important?

This research is important because it provides valuable insights into the incidence, clinical features, risk factors, aetiology, antimicrobial resistance, and outcomes of polymicrobial bloodstream infections (PBSI) in patients with cancer. Understanding the factors associated with PBSI and its impact on patient outcomes can help healthcare professionals identify patients at risk, improve diagnostic and treatment strategies, and ultimately enhance patient care and survival rates. Key Takeaways: 1. PBSI is a frequent complication in patients with cancer and is responsible for high mortality rates. 2. Gram-negative organisms are the most frequent causative agents in PBSI, with Enterococcus spp. being especially frequent among Gram-positive pathogens. 3. Multidrug-resistant (MDR) organisms are more commonly found in PBSI than in monomicrobial bloodstream infections (MBSI), which is a concern for patients with cancer as inadequate initial empirical antibiotic therapy may negatively influence outcomes. 4. Risk factors for PBSI include cholangitis, biliary stenting, neutropenia, corticosteroids, neutropenic enterocolitis, and other abdominal infections. 5. A high-risk MASCC index score, corticosteroid use, persistent bacteraemia, and septic shock are associated with higher mortality rates in patients with PBSI.