Abstract
The present study was conducted to determine trends in the quantitative bacterial load patterns of bacterial bloodstream infections (BSI) caused by various bacteria in patients receiving care at a comprehensive cancer center. Bacterial loads of all consecutive quantitative blood cultures performed during 1998 and 2004 were graded quantitatively. Gram-positive bacteria (GPB) were responsible for the majority of BSI episodes in both years studied: 740 of 1,055 (73%) in 1998 and 820 of 1,025 (82%) in 2004. Compared with GPB infections, a significant proportion of infections caused by Gram-negative bacteria was associated with a high bacterial load (HBL) (11 vs 28% in 1998 and 10 vs 30% in 2004; p<0.001). In 2004, BSI episodes due to non-Pseudomonas non-fermentative GNB (Stenotrophomonas maltophilia and Acinetobacter spp) were significantly associated with a HBL compared to BSI due to Pseudomonas aeruginosa (47 vs 23%; p<0.05); this was not the case in 1998. Conversely, the HBLs commonly associated with BSI due to Staphylococcus aureus (50%) and Streptococcus spp (35%) versus coagulase-negative staphylococci (13%; p<0.0001) during 1998 were not noted during 2004 (22% Staphylococcus aureus, 20% Streptococcus spp, 21% coagulase-negative staphylococci; p>0.5). The spectrum of BSI continues to change and its prognostic implications in cancer patients needs further study.
Similar content being viewed by others
References
Safdar A, Armstrong D (2001) Infectious morbidity in critically ill patients with cancer. Critical Care Clin 17:531–570
Rolston KV (2004) The Infectious Diseases Society of America 2002 guidelines for the use of antimicrobial agents in patients with cancer and neutropenia: salient features and comments. Clin Infect Dis 39(Suppl 1):44–48
Chatzinikalaou I, Abi-Said D, Bodey GP, Rolston KVI, Tarrand JJ, Samonis G (2000) Recent experience with Pseudomonas aeruginosa bacteremia in patients with cancer. Arch Intern Med 160:501–509
Rolston KVI, Tarrand JJ (1999) Pseudomonas aeruginosa—still a frequent pathogen in patients with cancer: 11-year experience at a comprehensive cancer center. Clin Infect Dis 29:463–464
Douard MC, Arlet G, Leverger G, Paulien R, Waintrop C, Clementi E, Eurin B, Schaison G (1991) Quantitative blood cultures for diagnosis and management of catheter-related sepsis in pediatric hematology and oncology patients. Intensive Care Med 17:30–35
Germanakis J, Stiakaki E, Galanakis E, Christidou A, Neonakis J, Dimitriou H, Tselentis Y, Kalmanti M (2002) Prognostic value of quantitative blood cultures for the outcome of central venous catheters in children. Scand J Infect Dis 34:680–682
Safdar A, Raad II (2004) Management and treatment. In: O’Grady N, Pittet D (eds) Catheter-related infections in the critically ill. Kluwer, Boston, pp 99–112
Backes RJ, Rouse MS, Henry NK, Geraci JE, Wilson WR (1986) Activity of penicillin combined with an aminoglycoside against group B Streptococcus in vitro and in experimental endocarditis. J Antimicrob Chemother 18:491–498
Baddour LM, Christensen GD, Bisno AL (1987) Bacterial concentration correlates in experimental endocarditis caused by Staphylococcus epidermidis. J Clin Microbiol 25:207–210
Enzler MJ, Rouse MS, Henry NK, Wilson WR (1987) In vitro and in vivo studies of streptomycin-resistant, penicillin-susceptible streptococci from patients with infective endocarditis. J Infect Dis 155:954–958
Garrison PK, Freedman LR (1970) Experimental endocarditis: I. Staphylococcus endocarditis in rabbits resulting from placement of a polyethylene catheter in the right side of the heart. Yale J Biol Med 42:394–410
Yuste J, Jado I, Gimenez MJ, Aguilar L, Molero F, Fenoll A, Casal J (2002) Modification of bacteremia by specific antibodies and relation with mortality in pneumococcal mouse sepsis model. Clin Exp Immunol 128:411–415
Whimbey E, Kiehn TE, Brannon P, Benezra D, Armstrong D (1987) Clinical significance of colony counts in immunosuppressed patients with Staphylococcus aureus bacteremia. J Infect Dis 155:1328–1330
Schonheyder HC, Gottschau A, Friland A, Rosdahl VT (1995) Mortality rate and magnitude of Staphylococcus aureus bacteremia as assessed by a semiquantitative blood culture system. Scand J Infect Dis 27:19–21
Elting LS, Rubenstein EB, Rolston KVI, Bodey GP (1997) Outcomes of bacteremia in patients with cancer and neutropenia: observations from two decades of epidemiological and clinical trials. Clin Infect Dis 25:247–259
Tarrand JJ, Guillot C, Wenglar M, Jackson J, Lajeunesse JD, Rolston KV (1991) Clinical comparison of the resin-containing BACTEC 26 Plus and the Isolator 10 blood culturing systems. J Clin Microbiol 29:2245–2249
Vuong C, Gerke C, Somerville GA, Fischer ER, Otto M (2003) Quorum-sensing control of biofilm factors in Staphylococcus epidermidis. J Infect Dis 188:706–718
Walsh AL, Smith MD, Wuthiekanun V, Suputtamongkol Y, Chaowagul W, Dance DA, Angus B, White NJ (1995) Prognostic significance of quantitative bacteremia in septicemic melioidosis. Clin Infect Dis 21:1498–1500
Vidal F, Mensa J, Almela M, Olona M, Martinez JA, Marco F, Lopez MJ, Soriano A, Horacajada JP, Gatell JM, Richart C (2003) Bacteremia in adults due to glucose non-fermentative gram-negative bacilli other than P. aeruginosa. QJM 96:227–234
Apisarnthanarak A, Mayfield JL, Garison T, McLendon PM, DiPersio JF, Fraser VJ, Polish LB (2003) Risk factors for Stenotrophomonas maltophilia bacteremia in oncology patients: a case-control study. Infect Control Hosp Epidemiol 24:269–274
Aisenberg G, Rolston K, Kontoyiannis DM, Raad I, Safdar A (2005) Stenotrophomonas maltophilia pneumonia (SmP) in 108 patients with cancer: matched case-control analysis in 44 individuals with low-risk of infection (1998–2004). In: Program and Abstracts of the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy. Abstract no. K-1535
Cherif H, Kronvall G, Bjorkholm M, Kalin M (2003) Bacteraemia in hospitalised patients with malignant blood disorders: a retrospective study of causative agents and their resistance profiles during a 14-year period without antibacterial prophylaxis. Hematol J 4:420–426
Lai CH, Chi CY, Chen HP, Chen TL, Lai CJ, Fung CP, Yu KW, Wong WW, Liu CY (2004) Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia bacteremia. J Microbiol Immunol Infect 37:350–358
Senol E, DesJardin J, Stark PC, Barefoot L, Snydman DR (2002) Attributable mortality of Stenotrophomonas maltophilia bacteremia. Clin Infect Dis 34:1653–1656
Raad I, Alrahwan A, Rolston K (1998) Staphylococcus epidermidis: emerging resistance and need for alternative agents. Clin Infect Dis 26:1182–1187
Micozzi A, Venditti M, Monaco M, Taglietti F, Santilli S, Martino P (2000) Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis 31:705–711
Martino R, Gomez L, Pericas R, Salazar R, Sola C, Sierra J, Garau J (2000) Bacteremia caused by non-glucose-fermenting gram-negative bacilli and Aeromonas species in patients with haematological malignancies and solid tumors. Eur J Clin Microbiol Infect Dis 19:320–323
Acknowledgements
We are grateful to Dr. Donald Armstrong, member emeritus, Memorial Sloan-Kettering Cancer Center, and Dr. Gerald P. Bodey, professor emeritus, M.D. Anderson Cancer Center for critical review of the manuscript and helpful comments.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Safdar, A., Rodriguez, G.H., Balakrishnan, M. et al. Changing trends in etiology of bacteremia in patients with cancer. Eur J Clin Microbiol Infect Dis 25, 522–526 (2006). https://doi.org/10.1007/s10096-006-0173-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-006-0173-4