Abstract
A total of 1051 bacteremic episodes (782 patients) were prospectively recorded in 10 cancer centers (9 French, 1 Belgian), with: patient's age (mean 53, range 1–89 years), underlying cancer, neutropenia (<1000 neutrophils/μl; 233), signs and symptoms, type of i.v. line (percutaneous central: 534; peripheral: 228; central implanted: 304), treatment, blood culture system, number of positive blood culture bottles/total obtained, time to growth. Of all episodes, 23.2% occurred within 48 h of admission. The patients were receiving systemic antibiotics at sampling (on AB) in 34.6% of cases. The 1147 pathogens isolated (86 polymicrobial) were: E. coli (10.7%), Klebsiella-Enterobacter-Serratia (6.1%), other enterobacteriaceae (2.2%), Pseudomonas aeruginosa (4.8%), other nonfermenters (4.7%), coagulase-negative staphylococci (CNS, 40.8%), Staphylococcus aureus (9.9%), streptococci (5.4%), enterococci (2.2%), anaerobes (3.4%), yeasts (3.5%), and other bacteria (6.9%). The CDC (Centers for Disease Control) criteria (1988) were used to assess significance: group 1: pathogenic species (616 episodes; 59%); group 2: clinical signs and isolation of a “contaminant” species (47; 4.5%); group 3: as in group 2 with an i.v. line and empiric antibiotic treatment (181 episodes including 176 CNS; 17%); group 4: non-significant (207 episodes including 203 CNS; 20%). Groups 1–3, in which the episodes were considered to be significant (844 episodes; 80%) were compared with non-significant episodes (Fisher). Significant differences (P≤0.05) were seen in time to growth (median growth within 24 h vs 48 h), fever (86% vs 54%), chills (40% vs 3%), hypotension (10% vs 2%), septic shock (9% vs 1%), polymicrobial etiology (10% vs 0.5%), and initiation of empiric antibiotic treatment (71% vs 4%). Bacteremic episodes of CDC groups 1,3 and 4 were further studied in episodes with a single isolate as a doubtful clinical significance (482 episodes) and episodes with ≥2 bottles positive of probable clinical significance (569 episodes; 54%). In group 1 (218 doubtful, 398 probably significant episodes) significant differences were seen in chills (36% vs 52%), shock (7% vs 13%), polymicrobial (8% vs 17%), initiation of empiric antibiotic treatment (60% vs 72%); in group 3 (87 doubtful, 94 probably significant) in time to growth delay; in group 4 (177 doubtful, 30 probably significant) in proportion with implanted catheter (26% vs 52%), fever (62% vs 10%), and time to growth. This study confirms the predominant role of Gram-positive cocci in bacteremia occurring in cancer patients.
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Acar J, Bergogne-Bérézin E, Chabbert Y, Cluzel R, Courtieu A, Courvalin P, et al (1990) Communiqué 1990 du Comité de l'Antibiogramme de la Société Française de Microbiologie. Pathol Biol 38:749–752
Awada A, Van der Auwera P, Meunier F, Daneau D, Klastersky J (1992) Streptococcal bacteremia in cancer patients. Clin Infect Dis 15:33–48
Bodey GP (1986) Intection in cancer patients. A continuing association. Am J Med 81 [Suppl 1A]:11–26
Cortalezzi A, Radaelli F, Mozzana R, Cesana BM, Baldini L, Polli EE (1985) Septicemia in hematologic malignancies: statistical analysis of prognostic factors. Haematologica (Pavia) 70:510–516
Coullioud D, Combe F, Latour JF, Chauvin F, Bigot P (1990) Incidence des infections nosocomiales dans un centre anticancérux: données cliniques et bactériologiques. Bull Cancer 77:893–900
Daley C, Lim I, Modra J, Wilkinson I (1990) Comparative evaluation of nonradiometric BACTEC and improved oxoid signal blood culture systems in a clinical laboratory. J Clin Microbiol 28:1586–1590
Elting LS, Bodey GP, Fainstein V (1986) Polymicrobial septicemia in the cancer patient. Medicine 65:218–225
EORTC International Antimicrobial Therapy Cooperative Group (1990) Gram-positive bacteremia in granulocytopenic cancer patients. Eur J Cancer 26:569–574
EORTC International Antimicrobial Therapy Cooperative Group (1991) Vancomycin added to empirical combination therapy for fever in granulocytopenic cancer patients. J Infect Dis 163:951–958
Fainstein V, Elting LS, Bodey GP (1987) Bacteremia by nonsporulating anaerobes in cancer patients. Medicine 68:151–162
Garner JS, Farvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140
Horan T, Culver D, Jarvis W, Emori G, Banerjee S, Martone W, Thornsberry C (1988) Pathogens causing nosocomial infections. Preliminary data from the National Nosocomial Infections Surveillance System. Antimicrob Newslett 5:65–67
Hughes WT, Armstrong D, Bodey GP, Feld R, Mandell GL, Meyers JD, Pizzo PA, Schimpff SC, Shenep JL, Wade JC, Young LS, Yow MD (1990) Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. J Infect Dis 161:381–396
Kagnoff MF, Armstrong D, Blevins A (1972) Bacteroides bacteremia. Experience in a hospital for neoplastic diseases. Cancer 29:245–271
Kellogg JA, Bankert DA (1992) Impact of a policy revision on collection of single blood cultures from pediatric and adult patients in a community hospital (abstract). 92nd General Meeting of the American Society for Microbiology, New Orleans, May 1992. American Society for Microbiology, Washington, DC, p 434
Kirchhoff LV, Sheagren JN (1985) Epidemiology and clinical significance of blood cultures positive for coagulase-negative Staphylococcus. Infect Control 6:479–486
Klastersky J (1988) Empirical antimicrobial therapy for febrile granulocytopenic cancer patients: lessons from four EORTC trials. Recent Results Cancer Res 108:53–60
MacGregor RR, Beaty HN (1972) Evaluation of positive blood cultures. Guidelines for early differentiation of contaminated from valid positive cultures. Arch Intern Med 130:84–87
Martin MA, Pfaller MA, Wenzel RP (1989) Coagulase-negative staphylococcal bacteremia. Mortality and hospital stay. Ann Intern Med 110:9–16
Murray PR (1991) Comparison of the lysis-centrifugation and agitated biphasic blood culture systems for detection of fungemia. J Clin Microbiol 29:96–98
Roberts FJ, Geere IW, Coldman A (1991) A three-year study of positive blood cultures, with emphasis on prognosis. Rev Infect Dis 13:34–46
Rotstein C, Cummings KM, Nicolaou AL, Lucey J, Fitzpatrick J (1988) Nosocomial infection rates at an oncology center. Infect Control Hosp Epidemiol 9:13–19
Verbist L (1991) Incidence of multi-resistance in Gram-negative bacterial isolates from intensive care units in Belgium: a surveillance study. Scand J Infect Dis Suppl 78:45–53
Viscoli C, Van der Auwera P, Meunier F (1988) Gram-positive infections in granulocytopenic patients: an important issue? J Antimicrob Chemother 21 [Suppl C]:149–156
Wade JC, Schimpff SC, Newman KA, Wiernik PH (1982) Staphylococcus epidermidis: an increasing cause of infection in patients with granulocytopenia. Ann Intern Med 97:503–508
Weinstein MP, Reller LB, Murphy JR, Lichtenstein KA (1983) The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 5:35–53
Weinstein MP, Reller LB, Murphy JR, Lichtenstein KA (1983) The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations with special reference to factors influencing prognosis. Rev Infect Dis 5:54–70
Weinstein MP, Reller LB, Murphy JR (1986) Clinical importance of polymicrobial bacteremia. Diagn Microbiol Infect Dis 5:185–196
Weinstein MP, Mirrett S, Reimer LG, Reller LB (1990) Effect of altered headspace atmosphere on yield and speed of detection of the Oxoid Signal blood culture system versus the BACTEC radiometric system. J Clin Microbiol 28:795–797
Whimbey B, Kiehn TE, Brannon P, Blevins A, Armstrong D (1987) Bacteremia and fungenia in patients with neoplastic disease. Am J Med 82:723–730
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M. Viot and M. Schneider, Centre Antoine-Lacassagne, Nice; V. Bussy, Centre Jean-Godinot, Reims; C. Lion, CHRU, Nancy; C. Minello, Centre George-François-Leclercq, Diion; A. Lobera, Fondation Bergognié, Bordeaux; F. Boineau, CHU, Bordeaux; M. Roussel-Delvallez, CHU, Lille; J. Beal and D. Lefèbvre, Centre Oscar-Lambret, Lille; J. Pusel, Centre Paul-Strauss, Strasbourg; J. L. Théard, Centre René-Gauducheau, Nantes; D. Coullioud, Centre Léon-Bérard, Lyon, France; P. Van der Auwera and J. Klastersky, Institut Jules Bordet, Brussels, Belgium
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Coullioud, D., Van der Auwera, P., Viot, M. et al. Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients. Support Care Cancer 1, 34–46 (1993). https://doi.org/10.1007/BF00326637
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DOI: https://doi.org/10.1007/BF00326637