The Etiology, Antibiotic Therapy and Outcomes of Bacteremic Skin and Soft-Tissue Infections in Onco-Hematological Patients
Valeria Castelli,
Enric Sastre-Escolà,
Pedro Puerta-Alcalde,
Leyre Huete-Álava,
Júlia Laporte-Amargós,
Alba Bergas,
Mariana Chumbita,
Mar Marín,
Eva Domingo-Domenech,
Ana María Badia-Tejero,
Paula Pons-Oltra,
Carolina García-Vidal,
Jordi Carratalà,
Carlota Gudiol
Affiliations
Valeria Castelli
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Enric Sastre-Escolà
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Pedro Puerta-Alcalde
Infectious Diseases Department, Hospital Clinic of Barcelona—IDIBAPS, 08036 Barcelona, Spain
Leyre Huete-Álava
Internal Medicine Department, Hospital Reina Sofía de Tudela, 31500 Tudela, Spain
Júlia Laporte-Amargós
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Alba Bergas
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Mariana Chumbita
Infectious Diseases Department, Hospital Clinic of Barcelona—IDIBAPS, 08036 Barcelona, Spain
Mar Marín
Oncology Department, Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
Eva Domingo-Domenech
Hematology Department, Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
Ana María Badia-Tejero
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Paula Pons-Oltra
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Carolina García-Vidal
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
Jordi Carratalà
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Carlota Gudiol
Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
Objectives: to assess the current epidemiology, antibiotic therapy and outcomes of onco- hematological patients with bacteremic skin and soft-tissue infections (SSTIs), and to identify the risk factors for Gram-negative bacilli (GNB) infection and for early and overall mortality. Methods: episodes of bacteremic SSTIs occurring in cancer patients at two hospitals were prospectively recorded and retrospectively analyzed. Results: Of 164 episodes of bacteremic SSTIs, 53% occurred in patients with solid tumors and 47% with hematological malignancies. GNB represented 45.5% of all episodes, led by Pseudomonas aeruginosa (37.8%). Multidrug resistance rate was 16%. Inadequate empirical antibiotic therapy (IEAT) occurred in 17.7% of episodes, rising to 34.6% in those due to resistant bacteria. Independent risk factors for GNB infection were corticosteroid therapy and skin necrosis. Early and overall case-fatality rates were 12% and 21%, respectively. Risk factors for early mortality were older age, septic shock, and IEAT, and for overall mortality were older age, septic shock and resistant bacteria. Conclusions: GNB bacteremic SSTI was common, particularly if corticosteroid therapy or skin necrosis. IEAT was frequent in resistant bacteria infections. Mortality occurred mainly in older patients with septic shock, resistant bacteria and IEAT. These results might guide empirical antibiotic therapy in this high-risk population.
