John Bartlett, MD


July 23, 2003

In This Article

Bacteremia in Patients With Malignancies

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 hospitals in the United States. Clin Infect Dis. 2003;36:1103-1110. Abstract This is a report from Surveillance and Control of Pathogens of Epidemiologic Importance (SCOPE), which is a consortium of 49 participating hospitals throughout the United States. The current review deals with 2340 clinically significant episodes of bloodstream infections from 1995 to 2001. The most frequent isolates were gram-positive, primarily coagulase-negative staph, Staphylococcus aureus and Enterococcus. There were sequential changes with gram-positive organisms accounting for 62% of isolates in 1995 and 76% in 2000. No source of bacteremia was identified in 57% of patients. The major predisposing causes were neutropenia (absolute neutrophil count < 1000/mcL) in 696 (30%) and central venous lines in 1945 (83%). The crude mortality rate was 36% for patients with neutropenia compared with 31% for those without neutropenia. The results by pathogen are summarized in Table 5 .

Comment: Bacteremia in immunocompetent patients usually results from a focal infection; in this series dealing with immunosuppressed patients, no source of infection was identified in the majority. The assumption is the GI tract. This study, like others, has shown the progressive increase in cases involving gram-positive bacteria, which accounted for 61% of all isolates in the review and 76% of those recovered in the year 2000.


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