Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-25T00:20:23.712Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcomes of Nosocomial Bloodstream Infections in Adult Neutropenic Patients: A Prospective Cohort and Matched Case-Control Study

Published online by Cambridge University Press:  02 January 2015

Hilmar Wisplinghoff ,
Oliver A. Cornely ,
Susanne Moser ,
Ullrich Bethe ,
Hartmut Stützer ,
Bernd Salzberger ,
Gerd Fätkenheuer  and
Harald Seifert
Hilmar Wisplinghoff
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany Department of Internal Medicine, University of Cologne, Cologne, Germany
Oliver A. Cornely
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Susanne Moser
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
Ullrich Bethe
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Hartmut Stützer
Affiliation:
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
Bernd Salzberger
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Gerd Fätkenheuer
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Harald Seifert*
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
*
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935 Cologne, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To examine the clinical and epidemiologic features, excess length of stay, extra costs, and mortality attributable to bloodstream infection (BSI) in neutropenic patients with hematologic malignancies.

Design:

Prospective cohort and matched case-control study.

Patients:

All adult neutropenic patients with hematologic malignancies admitted to Cologne University Hospital between May 1, 1997, and April 30, 1998, were prospectively observed. Case-patients were defined as patients with nosocomial BSI; control-patients were selected among patients without BSI.

Results:

During the study period, the BSI rate in neutropenic patients was 14.3 per 100 neutropenic episodes. Eighty-four case-patients were included. Matching was successful for 96% of the cohort; 81 matched pairs were studied. The mean total length of stay was significantly longer for patients with BSI than for control-patients (37 vs 29 days; P = .002). Extra costs attributable to the infection averaged $3,200 (U.S.) per patient. The crude mortality rates of case-patients and control-patients were 16% and 4%, respectively (P = .013), with an attributable mortality of 12% (odds ratio, 11). Eighty-seven percent of patients met the criteria for sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine. Severe sepsis or septic shock occurred in 13% of patients and was correlated with mortality (55% vs 10% in patients without severe sepsis or septic shock; P =.01).

Conclusions:

Nosocomial BSI in neutropenic patients is significantly associated with an excess length of hospital stay, extra costs, and excess mortality. Severe sepsis and septic shock are closely correlated with an adverse outcome.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 905 - 911
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Pittet, D, Li, N, Woolson, RF, Wenzel, RP. Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model. Clin Infect Dis 1997;24:1068–1078.10.1086/513640Google Scholar
2. Warren, DK, Zack, JE, Elward, AM, Cox, MJ, Fraser, VJ. Nosocomial primary bloodstream infections in intensive care unit patients in a non-teaching community medical center: a 21-month prospective study. Clin Infect Dis 2001;33:1329–1335.10.1086/322483Google Scholar
3. Coffin, BA, Leather, HL, Wingard, JR, Ramphai, R. Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 2001;33:947–953.Google Scholar
4. National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-April 2000, issued June 2000. Am J Infect Control 2000;28:429–448.10.1067/mic.2000.110544Google Scholar
5. Pittet, D, Li, N, Wenzel, RP. Association of secondary and polymicrobial nosocomial bloodstream infections with higher mortality. Eur J Clin Microbiol Infect Dis 1993;12:813–819.10.1007/BF02000400Google Scholar
6. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.10.1001/jama.1994.03510440058033Google Scholar
7. Kreger, BE, Craven, DE, Carling, PC, McCabe, WR. Gram-negative bacteremia: III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med 1980;68:332–343.10.1016/0002-9343(80)90101-1Google Scholar
8. Weinstein, MP, Relier, LB, Murphy, JR, Lichtenstein, KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults: I. Laboratory and epidemiologic observations. Reviews of Infectious Diseases 1983;5:35–53.10.1093/clinids/5.1.35Google Scholar
9. Gatell, JM, Trilla, A, Latorre, X, et al. Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis. Reviews of Infectious Diseases 1988;10:203–210.10.1093/clinids/10.1.203Google Scholar
10. DiGiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.10.1164/ajrccm.160.3.9808145Google Scholar
11. Fagon, JY, Chastre, J, Novara, A, Medioni, P, Gibert, C. Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: the ODIN model. Intensive Care Med 1993;19:137–144.10.1007/BF01720528Google Scholar
12. Fagon, JY, Chastre, J, Vuagnat, A, Trouillet, JL, Novara, A, Gibert, C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996;275:866–869.10.1001/jama.1996.03530350048033Google Scholar
13. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159–167.10.1093/oxfordjournals.aje.a113988Google Scholar
14. Donowitz, LG, Haley, CE, Gregory, WW, Wenzel, RR. Neonatal intensive care unit bacteremia: emergence of gram-positive bacteria as major pathogens. Am J Infect Control 1987;15:141–147.10.1016/0196-6553(87)90137-4Google Scholar
15. Dimick, JB, Pelz, RK, Consunji, R, Swoboda, SM, Hendrix, CW, Lipsett, PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg 2001;136:229–234.10.1001/archsurg.136.2.229Google Scholar
16. Klastersky, J. Current attitudes for therapy of febrile neutropenia with consideration to cost-effectiveness. Curr Opin Oncol 1998;10:284–290.10.1097/00001622-199807000-00002Google Scholar
17. Madani, TA. Clinical infections and bloodstream isolates associated with fever in patients undergoing chemotherapy for acute myeloid leukemia. Infection 2000;28:367–373.10.1007/s150100070007Google Scholar
18. Gaytan-Martinez, J, Mateos-Garcia, E, Sanchez-Cortes, E, Gonzalez-Llaven, J, Casanova-Cardiel, LJ, Fuentes-Allen, JL. Microbiological findings in febrile neutropenia. Arch Med Res 2000;31:388–392.10.1016/S0188-4409(00)00080-1Google Scholar
19. Serody, JS. Fever in immunocompromised patients. N Engl J Med 2000;342:217–218.Google Scholar
20. Krupova, I, Kaiserova, E, Foltinova, A, et al. Bacteremia and fungemia in pediatric versus adult cancer patients after chemotherapy: comparison of etiology, risk factors and outcome. J Chemother 1998;10:236–242.10.1179/joc.1998.10.3.236Google Scholar
21. Krcmery, V Jr, Spanik, S, Krupova, I, et al. Bacteremia due to multiresistant gram-negative bacilli in neutropenic cancer patients: a case controlled study. J Chemother 1998;10:320–325.10.1179/joc.1998.10.4.320Google Scholar
22. Ehni, WF, Relier, LB, Ellison, RT. Bacteremia in granulocytopenic patients in a tertiary-care general hospital. Reviews of Infectious Diseases 1991;13:613–619.10.1093/clinids/13.4.613Google Scholar
23. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.10.1016/0196-6553(88)90053-3Google Scholar
24. American College of Chest Physicians/Society of Critical Care Medicine. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:846–875.Google Scholar
25. Wey, SB, Mori, M, Pfaller, MA, Woolson, RF, Wenzel, RP. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 1988;148:2642–2645.10.1001/archinte.1988.00380120094019Google Scholar
26. Pittet, D, Wenzel, RP. Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177–1184.10.1001/archinte.1995.00430110089009Google Scholar
27. Garrouste-Orgeas, M, Chevret, S, Mainardi, JL, Timsit, JF, Misset, B, Carlet, J. A one-year prospective study of nosocomial bacteraemia in ICU and non-ICU patients and its impact on patient outcome. J Hosp Infect 2000;44:206–213.10.1053/jhin.1999.0681Google Scholar
28. Rubio, M, Palau, L, Vivas, JR, et al. Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol 1994;15:101–104.10.2307/30145539Google Scholar
29. Bochud, PY, Eggiman, P, Calandra, T, Van Melle, G, Saghafi, L, Francioli, P. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis 1994;18:25–31.10.1093/clinids/18.1.25Google Scholar
30. Gonzalez-Barca, E, Fernandez-Sevilla, A, Carratala, J, Granena, A, Gudiol, F. Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institution. Eur J Clin Microbiol Infect Dis 1996;15:291–296.10.1007/BF01695660Google Scholar
31. Bochud, YP, Cornetta, A, Francioli, P. Virulent infections caused by alpha-hemolytic streptococci in cancer patients and their management. Curr Opin Infect Dis 1997;10:422–430.10.1097/00001432-199712000-00002Google Scholar
32. Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29:239–244.10.1086/520192Google Scholar
33. Wisplinghoff, H, Seifert, H, Wenzel, RP, Edmond, MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in U.S. hospitals. Clin Infect Dis 2003;36:1103–1110.10.1086/374339Google Scholar
34. Hann, I, Viscoli, C, Paesmans, M, Gaya, H, Glauser, M. A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol 1997;99:580–588.10.1046/j.1365-2141.1997.4453255.xGoogle Scholar
35. Spanik, S, Kukuckova, E, Pichna, P, et al. Analysis of 553 episodes of monomicrobial bacteraemia in cancer patients: any association between risk factors and outcome to particular pathogen? Support Care Cancer 1997;5:330–333.10.1007/s005200050083Google Scholar
36. Carratala, J, Alcaide, F, Fernandez-Sevilla, A, Corbella, X, Linares, J, Gudiol, F. Bacteremia due to viridans streptococci that are highly resistant to penicillin: increase among neutropenic patients with cancer. Clin Infect Dis 1995;20:1169–1173.10.1093/clinids/20.5.1169Google Scholar
37. Wisplinghoff, H, Reinert, RR, Comely, O, Seifert, H. Molecular relationships and antimicrobial susceptibilities of viridans group streptococci isolated from blood of neutropenic cancer patients. J Clin Microbiol 1999;37:1876–1880.10.1128/JCM.37.6.1876-1880.1999Google Scholar
38. Linden, PK Clinical implications of nosocomial gram-positive bacteremia and superimposed antimicrobial resistance. Am J Med 1998;104:24S–33S.10.1016/S0002-9343(98)00152-1Google Scholar
39. Wenzel, RP, Edmond, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174–177.10.3201/eid0702.010203Google Scholar
40. Raymond, DP, Pelletier, SJ, Crabtree, TD, Gleason, TG, Pruett, TL, Sawyer, RG. Impact of bloodstream infection on outcomes among infected surgical inpatients. Ann Surg 2001;233:549–555.10.1097/00000658-200104000-00011Google Scholar
41. Renaud, B, Brun-Buisson, C. Outcomes of primary and catheter-related bacteremia: a cohort and case-control study in critically ill patients. Am J Hespir Crit Care Med 2001;163:1584–1590.10.1164/ajrccm.163.7.9912080Google Scholar
42. Martin, MA, Pfaller, MA, Wenzel, RP. Coagulase-negative staphylococcal bacteremia: mortality and hospital stay. Ann Intern Med 1989;110:9–16.10.7326/0003-4819-110-1-9Google Scholar
43. Landry, SL, Kaiser, DL, Wenzel, RP. Hospital stay and mortality attributed to nosocomial enterococcal bacteremia: a controlled study. Am J Infect Control 1989;17:323–329.10.1016/0196-6553(89)90001-1Google Scholar
44. Pittet, D, Rangel-Frausto, S, Li, N, et al. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med 1995;21:302–309.10.1007/BF01705408Google Scholar
45. Rangel-Frausto, MS, Pittet, D, Costigan, M, Hwang, T, Davis, CS, Wenzel, RP. The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study. JAMA 1995;273:117–123.10.1001/jama.1995.03520260039030Google Scholar
46. Sparrelid, E, Hagglund, H, Remberger, M, et al. Bacteraemia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection. Bone Marrow Transplant 1998;22:795–800.10.1038/sj.bmt.1701404Google Scholar
47. Engelhard, D, Elishoov, H, Strauss, N, et al. Nosocomial coagulase-negative staphylococcal infections in bone marrow transplantation recipients with central vein catheter: a 5-year prospective study. Transplantation 1996;61:430–434.10.1097/00007890-199602150-00020Google Scholar