Clinical and Translational Oncology

, Volume 21, Issue 2, pp 187–196 | Cite as

Bloodstream infection in patients with head and neck cancer: a major challenge in the cetuximab era

  • M. Marín
  • C. GudiolEmail author
  • F. Castet
  • M. Oliva
  • I. Peiró
  • C. Royo-Cebrecos
  • J. Carratalà
  • R. Mesia
Research Article



To assess the impact of bloodstream infection (BSI) in patients with head and neck cancer (HNC) in the cetuximab era.


We prospectively analysed the epidemiology, microbiology and outcomes of 51 BSI episodes occurring in 48 patients with HNC (2006–2017). We performed a retrospective matched-cohort study (1:2) to determine the risk factors for BSI. Finally, we compared patients who died with those who survived to identify risk factors for mortality.


The most frequent HNC localization was the oropharynx (43%), and pneumonia was the most frequent source (25%). Gram-positive BSI occurred in 55% cases, mainly due to Streptococcus pneumoniae (21%), and among Gram-negatives, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most frequent. Hypoalbuminemia (OR 8.4; 95% CI, 3.5–19.9), previous chemotherapy (OR, 3.2; 95% CI, 1.3–7.4) and cetuximab therapy (OR, 2.8; 95% CI, 1.6–6.7) were significant risk factors for BSI. Patients with BSI had a higher overall case-fatality rate than patients without BSI (OR, 4.4; 95% CI, 1.7–11.8). Hypoalbuminemia was an independent risk factor for the early (7 day) and overall (30 day) case-fatalities, with ORs of 0.8 (95% CI, 0.6–0.9) and 0.8 (95% CI, 0.7–0.97), respectively. The presence of comorbidities (OR, 7; 95% CI, 1.4–34) was also an independent risk factor for overall case-fatality.


BSI causes high mortality in patients with HNC and is most often secondary to pneumonia. It occurs mainly among patients with hypoalbuminemia who receive treatment with cetuximab or chemotherapy. The development of BSI in patients with HNC impairs their outcome, especially in the presence of hypoalbuminemia and comorbidities.


Head and neck cancer Bloodstream infection Cetuximab Chemotherapy Hypoalbuminemia 



This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This observational study was approved by the Institutional Review Board Comité Ético de Investigación Clínica del Hospital Universitari de Bellvitge (Ethics Committee of Clinical Research-Hospital Universitari de Bellvitge). To protect personal privacy, identifying information of each patient in the electronic database was encrypted.

Informed consent

Informed consent was waived by the Clinical Research Ethics Committee because no intervention was involved and no patient identifying information was included.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Department of Medical OncologyCatalan Institute of Oncology (ICO), L’HospitaletBarcelonaSpain
  2. 2.Department of Infectious DiseasesHospital Universitari de BellvitgeBarcelonaSpain
  3. 3.IDIBELL (Institut d’Investigació Biomèdica de Bellvitge)L’HospitaletBarcelonaSpain
  4. 4.REIPI (Spanish Network for Research in Infectious Diseases)BarcelonaSpain
  5. 5.Department of MedicineUniversity of BarcelonaBarcelonaSpain
  6. 6.Clinical Nutrition UnitCatalan Institute of Oncology (ICO), L’HospitaletBarcelonaSpain

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