Pathogens (Sep 2022)

<i>Pseudomonas aeruginosa</i> Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors

  • Cristina Royo-Cebrecos,
  • Julia Laporte-Amargós,
  • Marta Peña,
  • Isabel Ruiz-Camps,
  • Pedro Puerta-Alcalde,
  • Edson Abdala,
  • Chiara Oltolini,
  • Murat Akova,
  • Miguel Montejo,
  • Malgorzata Mikulska,
  • Pilar Martín-Dávila,
  • Fabian Herrera,
  • Oriol Gasch,
  • Lubos Drgona,
  • Hugo Manuel Paz Morales,
  • Anne-Sophie Brunel,
  • Estefanía García,
  • Burcu Isler,
  • Winfried V. Kern,
  • Zaira R. Palacios-Baena,
  • Guillermo Maestro de la Calle,
  • Maria Milagro Montero,
  • Souha S. Kanj,
  • Oguz R. Sipahi,
  • Sebnem Calik,
  • Ignacio Márquez-Gómez,
  • Jorge I. Marin,
  • Marisa Z. R. Gomes,
  • Philipp Hemmatti,
  • Rafael Araos,
  • Maddalena Peghin,
  • José Luis del Pozo,
  • Lucrecia Yáñez,
  • Robert Tilley,
  • Adriana Manzur,
  • Andrés Novo,
  • Jordi Carratalà,
  • Carlota Gudiol

DOI
https://doi.org/10.3390/pathogens11101132
Journal volume & issue
Vol. 11, no. 10
p. 1132

Abstract

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Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006–May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p p p p p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.

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