Polymicrobial Infection in Patients with Cancer: An Underappreciated and Underreported Entity

Rolston, Kenneth V. I.; Bodey, Gerald P.; Safdar, Amar

doi:10.1086/518873

Cited by 138 publications

(90 citation statements)

References 44 publications

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“…In a large study, 14% of 2,340 patients with underlying malignancy and an episode of nosocomial bloodstream infection had a polymicrobial infection (22). In cancer patients, neutropenia is considered as an important factor for polymicrobial bacteremia (23,24). However, 24% of cancer patients with polymicrobial bacteremia were not neutropenic (22).…”

Section: Discussionmentioning

confidence: 99%

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

Lay

Zhuang

et al. 2010

Intern. Med.

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Background Part of Aeromonas bacteremia is polymicrobial infection. However, a clinical comparison of monomicrobial and polymicrobial Aeromonas bacteremia has not hitherto been reported. Methods A retrospective analysis of medical records of patients with Aeromonas bacteremia at three large referral hospitals in Taiwan for an 8-year period (2001-2008) was conducted. Results There were 154 patients with monomicrobial Aeromonas bacteremia and 62 patients with polymicrobial Aeromonas bacteremia. In the polymicrobial infections, E. coli was the most common combined pathogen (42%), followed by Klebsiella spp. (24%) and Enterobacter spp. (16%). Multivariate logistic regression analysis revealed solid cancer as the risk factor for polymicrobial Aeromonas bacteremia, with male gender and cirrhosis as risk factors for monomicrobial Aeromonas bacteremia. However, of all types of solid cancer, hepatoma was associated with monomicrobial Aeromonas bacteremia. APACHE II score was the most important prognostic factor in both groups. Conclusion Aeromonas bacteremia in patients with cirrhosis or male gender tended to be monomicrobial. Polymicrobial Aeromonas bacteremia was associated with solid cancers. In either polymicrobial or monomicrobial Aeromonas bacteremia, prognosis could be predicted according to disease severity measured by APACHE II score.

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Section: Discussionmentioning

confidence: 99%

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

Lay

Zhuang

et al. 2010

Intern. Med.

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“…41 The issue of polymicrobial BSIs is likely underestimated, partially because of the lack of a common definition, but it is probably applicable to the 8-32% of total BSI cases. 42 …”

Section: Increase In Gram-negativesmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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“…14 A polymicrobial infection episode was defined as 41 disease-associated organism isolated from the blood or bronchial cultures in samples obtained within 72 h of each other. 15 An infection episode was considered to be microbiologically documented if a disease-causing microorganism was identified from a sterile body site or from a non-sterile site that was considered to be infected on physical examination. Infections were clinically documented if fever or other signs and symptoms of infection were present, along with radiographic features consistent with pulmonary, sinus, brain, bone, skin and soft tissue infection, but no pathogen was isolated.…”

Section: Definitionsmentioning

confidence: 99%

Infections in non-myeloablative hematopoietic stem cell transplantation patients with lymphoid malignancies: spectrum of infections, predictors of outcome and proposed guidelines for fungal infection prevention

Safdar

Rodriguez

Mihu

et al. 2009

Bone Marrow Transplant

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The overall risk of infections is lower in patients undergoing non-myeloablative allogeneic stem cell transplantation (NST) than in conventional stem cell transplant recipients. We sought to evaluate conditions associated with increased risk of infections after NST. In 81 patients, 187 infection episodes were noted; chronic lymphocytic leukemia (138 episodes/100 person-years) and recipients of matched unrelated donor graft (128 episodes/100 person-years) had higher risk of infection. Only half of the cytomegalovirus (CMV) infections occurred 31-100 days after transplantation. Most patients with CMV infection were non-neutropenic (100%), had lymphoma (76%), were younger (o55 years; 72%) and had received matched related donor (MRD) graft (72%). However, graft-versus-host disease (GVHD) was present in only 15% of these patients. Seven (78%) of nine invasive fungal infections (IFI) were diagnosed 4100 days after NST and were associated with high mortality (78%). Most patients with IFI were also not neutropenic (100%), had received MRD graft (100%), had lymphoma (78%) and were given systemic steroids (78%); unlike CMV infection, 67% of these patients also had GVHD. On the basis of our results, we propose that NST recipients with lymphoma treated with high-dose corticosteroids for GVHD be considered for antifungal prophylaxis or preemptive antifungal therapy.

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Polymicrobial Infection in Patients with Cancer: An Underappreciated and Underreported Entity

Cited by 138 publications

References 44 publications

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

Bloodstream infections in neutropenic cancer patients: A practical update

Infections in non-myeloablative hematopoietic stem cell transplantation patients with lymphoid malignancies: spectrum of infections, predictors of outcome and proposed guidelines for fungal infection prevention

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