Table 4.
Factors potentially associated with 10-day mortality according to characteristics evaluated and results of bivariate and multivariate tests in 161 episodes of bacteremia caused by Streptococcus pneumoniae in cancer patients.
| Variable | Bivariate analysis/multivariate analysis | |
|---|---|---|
| OR (95% CI) | p value | |
| Sex | 0.034 | |
| Female | 1 | |
| Male | 2.155 (1.05–4.42) | |
| Age (years) | 1.007 (0.98–1.04) | 0.643** |
| Ethnicity | 0.159# | |
| Asian | & | |
| White | 1.118 (0.46–2.72) | |
| Black | 0.739 (0.23–2.38) | |
| Mixed | 1 | |
| Comorbidities | ||
| Systemic arterial hypertension | 0.785 (0.41–1.52) | 0.471 |
| Diabetes mellitus | 0.37 (0.14–1.52) | 0.036 |
| Congestive heart failure | 0.373 (0.08–1.77) | 0.340* |
| COPD | 0.878 (0.46–1.69) | 0.698 |
| Smoking | 0.754 (0.39–1.45) | 0.399 |
| Splenectomy | & | > 0.999* |
| AIDS/HIV | 1.2 (0.28–5.22) | > 0.999* |
| Neoplasm | 0.056# | |
| Solid tumors | ||
| Head and necka | 1 | |
| GTI | 1.079 (0.4–2.93) | |
| Respiratory tract | 0.517 (0.16–1.71) | |
| Liver/bile ducts | 0.295 (0.05–1.69) | |
| Breasts | 0.591 (0.09–3.86) | |
| Pancreas | 1.182 (0.14–9.83) | |
| Female genitourinary | 0.394 (0.04 -4.35) | |
| Bones/cartilage/SST | 0.394 (0.04–4.35) | |
| Male genitourinary | & | |
| Timo/parotid | & | |
| Hematologic neoplasms | ||
| Multiple myeloma | 0.131 (0.03–0.70) | |
| Non-Hodgkin's lymphoma | 0.197 (0.04–1.08) | |
| Hodgkin's lymphoma | 0.394 (0.04–0.82) | |
| Leukemias | & | |
| Karnofsky | 0.053 | |
| 90/100 | 1 | |
| < 90 | 2.014 (0.98–4.12) | |
| ECOG | 0.032 | |
| 0/1/2 | 1 | 0.937 |
| 3/4 | 2.25 (1.06–4.77)/5.93 (2.04–17.22) *** | 0.937/0.001*** |
| Presence of metastases | 2.218 (1.11–4.41) | 0.022 |
| Radiotherapy past month | 1.354 (0.58–3.14) | 0.479 |
| Chemotherapy past month | 0.941 (0.49–1.83) | 0.858 |
| Monoclonal antibodies past month | 6.235 (0.63–61.43) | 0.110* |
| Corticotherapy past month | 1.331 (0.66–2.67) | 0.421 |
| Community-acquired infection | 1.029 (0.51–2.06) | 0.72 |
| Health-care infection | 0.972 (0.49–1.95) | 0.72 |
| Primary site infection | 0.018# | |
| Lung | 1 | |
| Abdomen | 0.372 (0.10–1.37) | |
| Bloodstream infection | & | |
| Central nervous system | & | |
| Oropharynx/facial sinuses | & | |
| SST | 1.612 (0.1–26.37) | |
| Biliary ducts | & | |
| Urinary tract | & | |
| Fever in the 48 h preceding the episode | 0.42 (0.21–0.82)/0.351 (0.14–0.88)*** | 0.01/(0.026)*** |
| Neutropenia | ||
| Neutropenia past month | 3.227 (1.56–6.67) | 0.001 |
| Current neutropenia | 3.91 (1.83–8.36)/4.006 (1.38–11.65)*** | < 0.001/0.011*** |
| Severe neutropenia past month | 3.369 (1.59–7.16) | 0.001 |
| Current severe neutropenia | 3.908 (1.78–8.59) | < 0.001 |
| Prolonged neutropenia past month | 1.347 (0.36–4.99) | 0.733* |
| Febrile neutropenia 48 h preceding the episode | 2.359 (1.05–5.29) | 0.034 |
| Antibiotics last month | 0.81 (0.40–1.67) | 0.571 |
| SOFA | 1.4 (1.24–1.60)/1.407 (1.2–1.66)*** | < 0.001£/ < 0.001*** |
| Strain susceptibility | & | 0.335* |
| MIC PEN | 1.16 (0.62–2.19) | 0.904£ |
| MIC CRO | 1.31 (0.27–6.23) | 0.369£ |
| PEN susceptibility (MIC ≤ 2) | & | 0.333* |
| CRO susceptibility (MIC ≤ 1) | & | & |
| CLI susceptibility | 1.089 (0.32–3.73) | > 0.999* |
| CHL susceptibility | & | 0.329* |
| ERY susceptibility | 1.98 (0.62–6.31) | 0.241 |
| LEV susceptibility | & | & |
| SXT susceptibility | 1.345 (0.68–2.68) | 0.398 |
| TET susceptibility | 2.017 (0.76–5.35) | 0.153 |
| VAN susceptibility | & | & |
| Vaccination | ||
| Vaccine serotype VCV 13b | 2.72 (1.21–6.14) | 0.014 |
| Vaccine serotype VPV 23c | 0.915 (0.38–2.2) | 0.842 |
| Pneumococcal vaccine before the episode | & | 0.539* |
| Pneumococcal vaccine in any time | & | & |
| Antimicrobial treatment | ||
| Instituted in the first 24 h | 0.359 (0.13–0.97) | 0.038 |
| 3rd and 4th generation cephalosporin | 0.331 (0.16–0.67) | 0.002 |
| Penicilinsd | 1.708 (0.87–63.36) | 0.119 |
| Fluoroquinolonese | 0.053 (0.01–0.40)/0.083 (0.01–0.71)*** | < 0.001/0.023*** |
| Glycopeptide/linezolid | 1.454 (0.75–2.81) | 0.266 |
| SMX/TMP | & | > 0.999* |
| Clindamycin | 0.777 (0.15–4.14) | > 0.999* |
| Polymicrobial bacteremia | 3.395 (1.39–8.28) | 0.005 |
Chi-square test; *Fisher exact test; #likelihood ratio test; **T-Student Test; £Mann–Whitney Test; &Cannot estimate; ***Multiple logistic regression.
COPD chronic obstructive pulmonary disease, GTI gastrointestinal tract (esophagus, stomach, small intestine, colon, anus and rectum), SST skin and soft tissue, PEN penicillin, CRO ceftriaxone, CLO chloramphenicol, ERY erythromycin, CLI clindamycin, VAN vancomycin, LEV levofloxacin, SXT trimethoprim-: sulfamethoxazole, TET tetracycline.
aHead and neck, oral cavity, larynx and pharynx.
bVaccine VCV 13, or pneumococcal conjugate vaccine 13.
cVaccine VPV 23. or pneumococcal polysaccharide vaccine 23.
dOxacillin, amoxicillin, piperacillin-tazobactam.
eMoxifloxacin, levofloxacin.MIC Minimum inhibitory concentration.