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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: blmusher@bcm.edu
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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.

References

Nault, V, Pepin, J, Beaudoin, M, Perron, J, Moutquin, J-M, Valiquette, L. Sustained impact of a computer-assisted antimicrobial stewardship intervention on antimicrobial use and length of stay. J Antimicrob Chemother 2017;72:933–940.Google ScholarPubMed
Álvarez-Lerma, F, Grau, S, Echeverría-Esnal, D, et al. A before-and-after study of the effectiveness of an antimicrobial stewardship program in critical care. Antimicrob Agents Chemother 2018;62(4):e01825–17.CrossRefGoogle ScholarPubMed
Anderson, DJ, Watson, S, Moehring, RW, et al. Feasibility of core antimicrobial stewardship interventions in community hospitals. JAMA Netw Open 2019;2(8):e199369.CrossRefGoogle ScholarPubMed
Campbell, TJ, Decloe, M, Gill, S, Ho, G, McCready, J, Powis, J. Every antibiotic, every day: maximizing the impact of prospective audit and feedback on total antibiotic use. PLoS One 2017;12(5):e0178434.CrossRefGoogle ScholarPubMed
Hwang, H, Kim, B. Impact of an infectious diseases specialist-led antimicrobial stewardship programmes on antibiotic use and antimicrobial resistance in a large korean hospital. Sci Rep 2018;8:14757.CrossRefGoogle Scholar
Katzman, M, Kim, J, Lesher, MD, et al. Customizing an electronic medical record to automate the workflow and tracking of an antimicrobial stewardship program. Open Forum Infect Dis 2019. doi: 10.1093/ofid/ofz352.CrossRefGoogle Scholar
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Executive summary: implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:1197–1202.CrossRefGoogle Scholar
Dellit, TH, Owens, RC, McGowan, JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.CrossRefGoogle Scholar
McGregor, JC, Weekes, E, Forrest, GN, et al. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform Assoc 2006;13:378–384.CrossRefGoogle ScholarPubMed
Rhodes, A, Evans, LE, Alhazzani, W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017;45:486–552.CrossRefGoogle ScholarPubMed
Alibek, K, Bekmurzayeva, A, Mussabekova, A, Sultankulov, B. Using antimicrobial adjuvant therapy in cancer treatment: a review. Infect Agent Cancer 2012;7:33.CrossRefGoogle ScholarPubMed
Klastersky, J, Georgala, A. Strategies for the empirical management of infection in cancer patients with emphasis on the emergence of resistant gram-negative bacteria. Crit Rev Oncol Hematol 2014;92:268–278.CrossRefGoogle ScholarPubMed
Cullen, M, Steven, N, Billingham, L, et al. Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas. N Engl J Med 2005;353:988–998.CrossRefGoogle ScholarPubMed
Taplitz, RA, Kennedy, EB, Bow, EJ, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol 2018;363:3043–3054.CrossRefGoogle Scholar
Perron, T, Emara, M, Ahmed, S. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. BMC Health Serv Res 2014;14:162.CrossRefGoogle ScholarPubMed
Rolston, KVI. Infections in cancer patients with solid tumors: a review. Infect Dis Ther 2017;6:69–83.CrossRefGoogle ScholarPubMed
Haddad, HE, Chaftari, A-M, Hachem, R, et al. Procalcitonin guiding antimicrobial therapy duration in febrile cancer patients with documented infection or neutropenia. Sci Rep 2018;8:1099.CrossRefGoogle ScholarPubMed
Abou Dagher, G, El Khuri, C, Chehadeh, AA-H, et al. Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon. BMJ Open 2017;7:e013502.CrossRefGoogle Scholar
National Early Warning Score (NEWS) 2. RCP London website. https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2 Published 2017. Accessed March 14, 2021.Google Scholar
Gando, S, Shiraishi, A, Abe, T, et al. The SIRS criteria have better performance for predicting infection than qSOFA scores in the emergency department. Sci Repts 2020;10:8095.CrossRefGoogle ScholarPubMed
Probst, L, Schalk, E, Liebregts, T, Zeremski, V, et al. Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study. J Intensive Care 2019;7:41.CrossRefGoogle ScholarPubMed
Lind, ML, Phipps, AI, Mooney, S, Liu, C, et al. Predictive value of 3 clinical criteria for sepsis (quick sequential organ failure assessment, systemic inflammatory response syndrome, and national early warning score) with respect to short-term mortality in allogeneic hematopoietic cell transplant recipients with suspected infections. Clin Infect Dis 2021;72:1220–1229.CrossRefGoogle ScholarPubMed
Usman, OA, Usman, AA, Ward, MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the emergency department. Am J Emerg Med 2019;37:1490–1497.CrossRefGoogle ScholarPubMed
Kutner, MH, editor. Applied Linear Statistical Models, 5th edition. Boston: McGraw-Hill Irwin; 2005. 1396 pp. (The McGraw-Hill/Irwin series operations and decision sciences).Google Scholar
Nicks, BA, Manthey, DE, Fitch, MT. The Centers for Medicare and Medicaid Services (CMS) community-acquired pneumonia core measures lead to unnecessary antibiotic administration by emergency physicians. Acad Emerg Med 2009;16:184–187.CrossRefGoogle ScholarPubMed
Akova, M, Paesmans, M, Calandra, T, Viscoli, C. International Antimicrobial Therapy Group of the European Organization for Research and Treatment of Cancer. A European organization for research and treatment of cancer-international antimicrobial therapy group study of secondary infections in febrile, neutropenic patients with cancer. Clin Infect Dis 2005;40:239–245.CrossRefGoogle Scholar
Bodro, M, Gudiol, C, Garcia-Vidal, C, et al. Epidemiology, antibiotic therapy and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in cancer patients. Support Care Cancer 2014;22:603–610.CrossRefGoogle ScholarPubMed
Castagnola, E, Caviglia, I, Pescetto, L, Bagnasco, F, Haupt, R, Bandettini, R. Antibiotic susceptibility of gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia. Future Microbiol 2015;10:357–364.CrossRefGoogle ScholarPubMed
Montassier, E, Batard, E, Gastinne, T, Potel, G, de La Cochetière, MF. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance. Eur J Clin Microbiol Infect Dis 2013;32:841–850.CrossRefGoogle ScholarPubMed
Gudiol, C, Tubau, F, Calatayud, L, et al. Bacteraemia due to multidrug-resistant gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother 2011;66:657–663.CrossRefGoogle ScholarPubMed
Gudiol, C, Carratalà, J. Antibiotic resistance in cancer patients. Expert Rev Anti Infect Ther 2014;12:1003–1016.CrossRefGoogle ScholarPubMed
Liu, VX, Fielding-Singh, V, Greene, JD, et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med 2017;196:856–863.CrossRefGoogle ScholarPubMed
Elkrief, A, Derosa, L, Kroemer, G, Zitvogel, L, Routy, B. The negative impact of antibiotics on outcomes in cancer patients treated with immunotherapy: a new independent prognostic factor? Ann Oncol 2019;30:1572–1579.CrossRefGoogle ScholarPubMed
Costa, RT, Nassar, AP, Caruso, P. Accuracy of SOFA, qSOFA, and SIRS scores for mortality in cancer patients admitted to an intensive care unit with suspected infection. J Crit Care 2018;45:52–57.CrossRefGoogle Scholar
Albaum, MN, Hill, LC, Murphy, M, et al. Interobserver reliability of the chest radiograph in community-acquired pneumonia. Chest 1996;110:343–350.CrossRefGoogle ScholarPubMed
Self, WH, Courtney, DM, McNaughton, CD, Wunderink, RG, Kline, JA. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med 2013;31:401–405.CrossRefGoogle ScholarPubMed
Musher, DM, Roig, IL, Cazares, G, Stager, CE, Logan, N, Safar, H. Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study. J Infect 2013;67:11–18.CrossRefGoogle ScholarPubMed
Seymour, CW, Gesten, F, Prescott, HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 2017; 376:2235–2244.CrossRefGoogle ScholarPubMed
Alam, N, Oskam, E, Stassen, PM, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respir Med 2018;6:40–50.CrossRefGoogle ScholarPubMed