Clinical characteristics of bloodstream infections in adult patients with solid tumours and a nomogram for mortality prediction: a 5-year case-controlled retrospective study in a tertiary-level hospital

Lijuan Xue; Ying Zhu; Mingxi Zong; Panpan Jiao; Jianguo Fu; Xian-Ming Liang; Juan Zhan

doi:10.3389/fcimb.2023.1228401

Clinical characteristics of bloodstream infections in adult patients with solid tumours and a nomogram for mortality prediction: a 5-year case-controlled retrospective study in a tertiary-level hospital

Front Cell Infect Microbiol. 2023 Aug 8:13:1228401. doi: 10.3389/fcimb.2023.1228401. eCollection 2023.

Authors

Lijuan Xue^{1

2}, Ying Zhu², Mingxi Zong², Panpan Jiao³, Jianguo Fu⁴, Xian-Ming Liang^{5

6}, Juan Zhan^{1

2}

Affiliations

¹ Department of Oncology Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
² School of Medicine, Xiamen University, Xiamen, China.
³ School of Pharmacy, Xiamen University, Xiamen, China.
⁴ Department of Nosocomial Infection and Preventive Health Care, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
⁵ Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
⁶ Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China.

Abstract

Background: Bloodstream infections (BSIs) are one of the leading causes of death in cancer patients. Nevertheless, the risk factors of BSIs in solid tumors have rarely been ascertained adequately.

Methods: We conducted a single-center case-controlled retrospective study from 2017 to 2021 among adults with solid tumors in a tertiary-level hospital. The BSIs and control group were matched by the propensity score matching method. We found independent risk factors of occurrence and death of BSIs using univariate and multivariate regression analysis. Additionally, a nomogram was constructed to predict the risk of mortality in BSIs.

Results: Of 602 patients with solid tumors in the study period, 186 had BSIs and 416 had non-BSIs. The incidence of BSIs was 2.0/1,000 admissions (206/102,704), and the 30-day mortality rate was 18.8% (35/186). Compared to the control group, the BSIs had longer hospital stays (24.5 days vs. 20.0 days), and higher frequency complicating with organ failure (10.5% vs. 2.4%), nephropathy (19.6% vs. 3.8%), comorbidities≥3 (35.5% vs. 20.0%), and liver-biliary-pancreatic infections (15.6% vs. 5.3%) (all P<0.001). Among the 186 patients with BSIs, 35 died within 30 days after BSIs. Gram-negative bacteria were the most frequent microorganisms (124/192, 64.6%). Liver cancer, organ failure, a high level of lactate dehydrogenase and septic shock were the independent hazardous factors for death of BSIs. What's more, a nomogram was constructed to predict the 30-day survival rate of BSIs, which was proved to have good accuracy (AUC: 0.854; 95% confidence interval: 0.785~0923) and consistency.

Conclusion: Being aware of the risk factors of BSIs redounds to take preventive measures to reduce the incidence and death of BSIs.

Keywords: bloodstream infections; mortality; nomogram; risk factors; solid tumors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Hospitals
Humans
Liver Neoplasms*
Nomograms
Retrospective Studies
Sepsis*

Grants and funding

This work was supported by Fujian Province Natural Science Foundation of China and Xiamen Medical and Health Science and Technology Project (Grant No. 2019J01550, 3502Z20194021 to JZ).