Abstract
Purpose
The aim of our study was to evaluate the frequency of “occult” bacteremia/fungemia as well as the diversity of pathogens involved in hematology patients treated with corticosteroids.
Methods
Daily surveillance blood cultures were taken from patients treated with corticosteroids as part of their intensive chemotherapy or during graft-versus-host disease following hematopoietic stem cell transplantation during a 3-year period (2006–2009). We reviewed the frequency of occult bacteremia/fungemia as well as the pathogens involved.
Results
During the 3-year period, 3,821 bottles were cultured from 215 patients and 4.9 % of the bottles tested were positive. Surveillance blood cultures revealed bloodstream infection in 24 % of the patients (definite bloodstream infection in 16 %). Seventy-five percent of patients were still afebrile when microorganisms were detected. The main risk group was acute lymphocytic leukemia patients undergoing remission induction chemotherapy. The pathogens cultured most frequently were coagulase-negative staphylococci, enterococci, Escherichia coli, and Pseudomonas aeruginosa.
Conclusions
A high incidence of occult bacteremia was detected by surveillance blood cultures. Further studies are needed to evaluate if a strategy based on surveillance blood cultures can reduce mortality related to bloodstream infections.
This is a preview of subscription content, log in via an institution to check access.
References
Lin MY, Weinstein RA, Hota B (2008) Delay of active antimicrobial therapy and mortality among patients with bacteremia: impact of severe neutropenia. Antimicrob Agents Chemother 52:3188–3194
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB (1997) The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 24:584–602
Freifeld AG, Bow EJ, Sepkowitz KA Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:e56–e93
O’Grady NP, Barie PS, Bartlett JG, Bleck T, Carroll K, Kalil AC, Linden P, Maki DG, Nierman D, Pasculle W, Masur H, American College of Critical Care Medicine, Infectious Diseases Society of America (2008) Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 36:1330–1349
Clinical and Laboratory Standards Institute (2007) Principles and procedures for blood cultures; approved guideline. CLSI document M47-A. Wayne, PA
Bailey JM (1991) New mechanisms for effects of anti-inflammatory glucocorticoids. Biofactors 3:97–102
Knudsen PJ, Dinarello CA, Strom TB (1987) Glucocorticoids inhibit transcriptional and post-transcriptional expression of interleukin 1 in U937 cells. J Immunol 139:4129–4134
Chizuka A, Kami M, Kanda Y, Murashige N, Kishi Y, Hamaki T, Kim SW, Hori A, Kojima R, Mori SI, Tanosaki R, Gomi H, Takaue Y (2005) Value of surveillance blood culture for early diagnosis of occult bacteremia in patients on corticosteroid therapy following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 35:577–582
Penack O, Keilholz U, Thiel E, Blau IW (2005) Value of surveillance blood cultures in neutropenic patients—a pilot study. Jpn J Infect Dis 58:171–173
Penack O, Rempf P, Eisenblatter M, Stroux A, Wagner J, Thiel E, Blau IW (2007) Bloodstream infections in neutropenic patients: early detection of pathogens and directed antimicrobial therapy due to surveillance blood cultures. Ann Oncol 18:1870–1874
Isenbergh HD (2007) Clinical microbiology procedures handbook. American Society of Microbiology Press (ASM), Washington
Conflict of interest
The study was not sponsored. The authors have full control of all primary data and agree to allow the journal to review the data if requested.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Joosten, A., Maertens, J., Verhaegen, J. et al. High incidence of bloodstream infection detected by surveillance blood cultures in hematology patients on corticosteroid therapy. Support Care Cancer 20, 3013–3017 (2012). https://doi.org/10.1007/s00520-012-1557-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-012-1557-x