Staphylococcus aureus bacteremia is one of the most serious bacterial infections and may lead to worse clinical outcomes in patients with prolonged severe neutropenia. However, clinical data on S. aureus bacteremia in neutropenic patients with hematologic malignancies are limited. We conducted two case-control studies using a 10-year prospective cohort of patients with S. aureus bacteremia. Neutropenic and non-neutropenic hematologic malignancy patients were compared on clinical characteristics and treatment outcomes. An additional matched case-control study using solid tumor patients was conducted. Risk factors for 12-week mortality were analyzed. Of 1643 patients with S. aureus bacteremia, 64 (3.9%) neutropenic and 108 (6.6%) non-neutropenic patients with hematologic malignancies were included in the study. There were no significant differences in the incidence of metastatic infection between the two groups (17.2% vs. 17.6%, p = 0.95), in contrast with a previous study that observed no metastatic infection in neutropenic patients. Twelve-week mortality in neutropenic patients with hematologic malignancies tended to be lower than in non-neutropenic patients with hematologic malignancies (15.6% vs. 26.9%, p = 0.09) and was significantly lower than in neutropenic patients with solid tumors (15.6% vs. 45.8%, p = 0.003). Independent risk factors for mortality in hematologic malignancy patients with S. aureus bacteremia were high Charlson comorbidity score, high APACHE II score, and skin and soft tissue infection. Neutropenia was not independently associated with mortality. Our findings suggest that neutropenia in hematologic malignancies may not affect the incidence of metastatic infection or 12-week mortality of S. aureus bacteremia.
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Safdar A, Armstrong D (2011) Infections in patients with hematologic neoplasms and hematopoietic stem cell transplantation: neutropenia, humoral, and splenic defects. Clin Infect Dis 53(8):798–806. https://doi.org/10.1093/cid/cir492
Ramphal R (2004) Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. Clin Infect Dis 39(Suppl 1):S25–S31. https://doi.org/10.1086/383048
Rosenberg PS, Alter BP, Bolyard AA, Bonilla MA, Boxer LA, Cham B, Fier C, Freedman M, Kannourakis G, Kinsey S, Schwinzer B, Zeidler C, Welte K, Dale DC (2006) The incidence of leukemia and mortality from sepsis in patients with severe congenital neutropenia receiving long-term G-CSF therapy. Blood 107(12):4628–4635. https://doi.org/10.1182/blood-2005-11-4370
Gudiol C, Tubau F, Calatayud L, Garcia-Vidal C, Cisnal M, Sanchez-Ortega I, Duarte R, Calvo M, Carratala J (2011) Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother 66(3):657–663. https://doi.org/10.1093/jac/dkq494
Cattaneo C, Quaresmini G, Casari S, Capucci MA, Micheletti M, Borlenghi E, Signorini L, Re A, Carosi G, Rossi G (2008) Recent changes in bacterial epidemiology and the emergence of fluoroquinolone-resistant Escherichia coli among patients with haematological malignancies: results of a prospective study on 823 patients at a single institution. J Antimicrob Chemother 61(3):721–728. https://doi.org/10.1093/jac/dkm514
Bousquet A, Malfuson JV, Sanmartin N, Konopacki J, MacNab C, Souleau B, de Revel T, Elouennass M, Samson T, Soler C, Foissaud V, Martinaud C (2014) An 8-year survey of strains identified in blood cultures in a clinical haematology unit. Clin Microbiol Infect 20(1):O7–O12. https://doi.org/10.1111/1469-0691.12294
Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr (2015) Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 28(3):603–661. https://doi.org/10.1128/cmr.00134-14
Espersen F, Frimodt-Moller N, Rosdahl VT, Jessen O, Faber V, Rosendal K (1987) Staphylococcus aureus bacteremia in patients with hematological malignancies and/or agranulocytosis. Acta Med Scand 222(5):465–470
Skov R, Gottschau A, Skinhoj P, Frimodt-Moller N, Rosdahl VT, Espersen F (1995) Staphylococcus aureus bacteremia: a 14-year nationwide study in hematological patients with malignant disease or agranulocytosis. Scand J Infect Dis 27(6):563–568
Shah MA, Sanders L, Lanclos K, Chamis AL, Gockerman J, Wray D, Corey GR, Fowler VG Jr (2002) Staphylococcus aureus bacteremia in patients with neutropenia. South Med J 95(7):782–784
Venditti M, Falcone M, Micozzi A, Carfagna P, Taglietti F, Serra PF, Martino P (2003) Staphylococcus aureus bacteremia in patients with hematologic malignancies: a retrospective case-control study. Haematologica 88(8):923–930
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR (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(4):427–431. https://doi.org/10.1093/cid/ciq147
Mc CW, Jackson G (1962) Gram-negative bacteremia: I. etiology and ecology. Arch Intern Med 110(6):847–855. https://doi.org/10.1001/archinte.1962.03620240029006
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16(3):128–140
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1–45. https://doi.org/10.1086/599376
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638. https://doi.org/10.1086/313753
Jenkins TC, Price CS, Sabel AL, Mehler PS, Burman WJ (2008) Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of Staphylococcus aureus bacteremia. Clin Infect Dis 46(7):1000–1008. https://doi.org/10.1086/529190
Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ (2002) Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 137(10):791–797
Gonzalez-Barca E, Carratala J, Mykietiuk A, Fernandez-Sevilla A, Gudiol F (2001) Predisposing factors and outcome of Staphylococcus aureus bacteremia in neutropenic patients with cancer. Eur J Clin Microbiol Infect Dis 20(2):117–119
van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB (2012) Predictors of mortality in Staphylococcus aureus bacteremia. Clin Microbiol Rev 25(2):362–386. https://doi.org/10.1128/cmr.05022-11
Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB, Cheng AC, Dudley T, Oddone EZ (2003) Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 163(17):2066–2072. https://doi.org/10.1001/archinte.163.17.2066
Sotman SB, Schimpff SC, Young VM (1980) Staphylococcus aureus bacteremia in patients with acute leukemia. Am J Med 69(6):814–818
Thwaites GE, Gant V (2011) Are bloodstream leukocytes Trojan horses for the metastasis of Staphylococcus aureus? Nat Rev Microbiol 9(3):215–222. https://doi.org/10.1038/nrmicro2508
Tanaka F, Goto H, Yokosuka T, Yanagimachi M, Kajiwara R, Naruto T, Nishimaki S, Yokota S (2009) Suppressed neutrophil function in children with acute lymphoblastic leukemia. Int J Hematol 90(3):311–317. https://doi.org/10.1007/s12185-009-0412-4
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Ryu, B., Lee, S.C., Kim, M. et al. Impact of neutropenia on the clinical outcomes of Staphylococcus aureus bacteremia in patients with hematologic malignancies: a 10-year experience in a tertiary care hospital. Eur J Clin Microbiol Infect Dis (2020). https://doi.org/10.1007/s10096-019-03802-w
- Staphylococcus aureus
- Hematologic malignancies