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Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors

Published online by Cambridge University Press:  28 July 2021

Jonathan M. Hyak Open the ORCID record for Jonathan M. Hyak [Opens in a new window] ,
Mayar Al Mohajer Open the ORCID record for Mayar Al Mohajer [Opens in a new window] ,
Daniel M. Musher Open the ORCID record for Daniel M. Musher [Opens in a new window]  and
Benjamin L. Musher Open the ORCID record for Benjamin L. Musher [Opens in a new window]
Jonathan M. Hyak
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas Department of Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
Mayar Al Mohajer
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas Department of Infection Prevention, Baylor St. Luke’s Medical Center, Houston, Texas
Daniel M. Musher
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas
Benjamin L. Musher*
Affiliation:
Department of Medicine, Baylor College of Medicine, Houston, Texas Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
*
Author for correspondence: Benjamin L. Musher, MD, E-mail: [email protected]
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Abstract

Objective:

To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients.

Design, setting, and participants:

We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded.

Methods:

Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics.

Results:

Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31–2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10–1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56–2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09–2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09–2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57).

Conclusions:

SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 9 , September 2022 , pp. 1112 - 1118
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. Preliminary data from this study were presented as a poster at IDWeek 2020, which was held virtually.

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