Table 1. Demographic and clinical data in neutropenic onco-hematological patients with monomicrobial catheter-related bloodstream infection.
| Overall n = 482 (%) | 1994–1998 n = 176 (%) | 1999–2003 n = 72 (%) | 2004–2008 n = 91 (%) | 2009–2013 n = 92 (%) | 2014–2018 n = 51 (%) | p-value | |
|---|---|---|---|---|---|---|---|
| Age–Median (IQR) | 49 (36–60) | 44 (33–53) | 45 (33–60) | 55 (42–61) | 53 (40–59) | 55 (48–66) | <0.001 |
| Sex (M) | 294 (61.0) | 101 (57.4) | 51 (70.8) | 56 (61.5) | 62 (67.4) | 24 (47.1) | 0.858 |
| Underlying disease | |||||||
| Acute leukemia | 226 (46.9) | 87 (49.4) | 40 (55.6) | 44 (48.4) | 25 (27.2) | 30 (58.8) | 0.628 |
| Other hematological diseases | 228 (47.3) | 78 (44.3) | 28 (38.9) | 37 (40.7) | 66 (71.7) | 19 (37.2) | 0.237 |
| Solid-organ tumor | 49 (10.2) | 19 (10.8) | 7 (9.7) | 14 (15.4) | 5 (5.4) | 4 (7.8) | 0.358 |
| HSCT | 174 (36.1) | 96 (54.5) | 22 (30.6) | 17 (18.7) | 25 (27.2) | 14 (27.5) | <0.001 |
| Mc Cabe prognostic score | |||||||
| Non-fatal | 114 (23.7) | 46 (26.1) | 13 (18.0) | 16 (17.6) | 24 (26.1) | 15 (29.4) | 0.325 |
| Ultimately fatal | 338 (70.1) | 122 (69.2) | 55 (76.4) | 68 (74.7) | 61 (66.3) | 32 (62.7) | |
| Rapidly fatal | 30 (6.2) | 8 (4.5) | 4 (5.6) | 7 (7.7) | 7 (7.6) | 4 (7.8) | |
| Type of catheter | |||||||
| Peripheral | 55 (11.4) | 25 (14.2) | 3 (4.2) | 7 (7.7) | 9 (9.8) | 11 (21.6) | 0.511 |
| Central | 427 (88.6) | 151 (85.8) | 69 (95.8) | 84 (92.3) | 83 (90.2) | 40 (78.4) | |
| Femoral | 12 (2.5) | 3 (1.7) | 2 (2.8) | 4 (4.4) | 3 (3.3) | 0 (0) | |
| Subclavian | 27 (5.6) | 13 (7.4) | 3 (4.2) | 7 (7.7) | 3 (3.3) | 1 (2.0) | |
| Jugular | 346 (71.8) | 131 (74.4) | 60 (83.3) | 60 (65.9) | 63 (68.5) | 32 (62.7) | |
| Port-a-Cath | 42 (8.7) | 4 (2.3) | 4 (5.6) | 13 (14.3) | 14 (15.2) | 7 (13.7) | |
| Catheter culture | |||||||
| Positive | 190 (39.4) | 51 (29.0) | 29 (40.3) | 51 (56.0) | 40 (43.5) | 19 (37.3) | <0.001 |
| Negative | 73 (15.1) | 21 (11.9) | 7 (9.7) | 7 (7.7) | 14 (15.2) | 24 (47.1) | |
| Not performed | 219 (45.4) | 104 (59.1) | 36 (50.0) | 33 (36.3) | 38 (41.3) | 8 (15.7) | |
| Days after catheter placement (IQR) | 19 (12–44) | 18 (11–40) | 22 (14–22) | 17 (10–30) | 18 (12–57) | 22 (15–77) | 0.059 |
| Clinical presentation | |||||||
| Fever | 460 (96.4) | 174 (99.4) | 69 (95.8) | 87 (95.6) | 84 (94.4) | 46 (92) | 0.004 |
| Shock | 21 (4.4) | 2 (1.1) | 2 (2.8) | 7 (7.7) | 6 (6.5) | 4 (8.2) | 0.004 |
| Prior antibiotic therapy | 282 (58.5) | 84 (47.7) | 55 (76.4) | 44 (48.4) | 64 (69.5) | 35 (68.6) | 0.004 |
| Beta-lactam | 145 (30.1) | 31 (17.6) | 26 (36.1) | 19 (20.9) | 45 (48.9) | 24 (47.1) | <0.001 |
| Penicillins± | 48 (10.0) | 7 (4.0) | 12 (16.7) | 7 (7.7) | 16 (17.4) | 6 (11.8) | 0.007 |
| Third-generation cephalosporin | 48 (10.0) | 14 (8.0) | 6 (8.3) | 6 (6.6) | 14 (15.2) | 8 (15.7) | 0.042 |
| Carbapenem | 67 (13.9) | 11 (6.3) | 7 (9.7) | 9 (9.9) | 25 (27.2) | 15 (29.4) | <0.001 |
| Aminoglycoside | 44 (9.1) | 10 (5.7) | 14 (19.4) | 4 (4.4) | 10 (10.9) | 6 (11.8) | 0.314 |
| Glycopeptide | 52 (10.8) | 9 (5.1) | 12 (16.7) | 12 (13.2) | 12 (13.0) | 7 (13.7) | 0.031 |
| Fluoroquinolone | 157 (32.6) | 47 (26.7) | 28 (38.9) | 27 (29.7) | 36 (39.1) | 19 (37.3) | 0.064 |
| >1 prior antibiotic | 123 (25.5) | 25 (14.2) | 18 (25) | 17 (18.7) | 40 (43.5) | 23 (45.1) | <0.001 |
| Current antibiotic therapy | 353 (73.2) | 134 (76.1) | 59 (81.9) | 52 (57.1) | 71 (77.2) | 37 (72.5) | 0.003 |
| Beta-lactam | 165 (34.2) | 54 (30.7) | 23 (31.9) | 25 (27.5) | 38 (41.3) | 25 (49.0) | 0.015 |
| Penicillins± | 30 (6.2) | 13 (7.4) | 6 (8.3) | 4 (4.4) | 5 (5.4) | 2 (3.9) | 0.247 |
| Third-generation cephalosporin | 51 (10.6) | 19 (10.8) | 6 (8.3) | 5 (5.5) | 13 (14.3) | 8 (15.7) | 0.328 |
| Carbapenem | 82 (17.0) | 21 (11.9) | 10 (13.9) | 16 (17.6) | 20 (21.7) | 15 (29.4) | 0.001 |
| Aminoglycoside | 40 (8.3) | 24 (13.6) | 7 (9.7) | 2 (2.2) | 5 (5.4) | 2 (3.9) | 0.002 |
| Glycopeptide | 73 (15.1) | 23 (13.1) | 11 (15.3) | 19 (20.9) | 12 (13.0) | 8 (15.7) | 0.600 |
| Fluoroquinolone | 215 (44.6) | 86 (48.9) | 38 (52.8) | 28 (30.8) | 44 (47.8) | 19 (37.3) | 0.100 |
| Combination therapy | 131 (27.2) | 49 (27.8) | 19 (26.4) | 27 (29.0) | 27 (29.3) | 17 (33.3) | 0.680 |
| IEAT | 145 (30.1) | 63 (36) | 31 (43.1) | 22 (24.2) | 15 (16.1) | 14 (27.5) | 0.001 |
| Overall mortality | 37 (7.8) | 8 (4.5) | 2 (2.8) | 8 (8.9) | 13 (14.6) | 6 (11.8) | 0.003 |
M: Male; IQR: Interquartile range; HSCT: Hematopoietic stem-cell transplant; COPD: Chronic obstructive pulmonary disease; BSI: Bloodstream infection; IEAT: Inappropriate empirical antibiotic treatment.
±Consisting of Piperacillin-Tazobactam, Amoxicillin, Ampicillin, Amoxicillin-Clavulanate and Cloxacillin.