Bloodstream Infections In Solid Tumour Malignancy: Clinical Outcomes And Prognostic Factors

Background: Contradicting findings on the association of adequate antimicrobial therapy and improved clinical outcomes among the solid tumour malignancy patients with bloodstream infections (BSI) were reported, where inadequate antimicrobial therapy have been both associated and not associated with mortality. Thus, this study aimed to evaluate the association of adequate antimicrobial therapy with desirable clinical outcomes, and to determine the prognostic factors of mortality for solid tumour malignancy patients with BSI. Methods and materials: Medical records of 130 randomly sampled adult patients with solid tumour malignancy at a national cancer centre of Malaysia, whom had bacteria growth in their blood culture between July 2017 and December 2018 were evaluated in this retrospective cross-sectional study. Results: Gram-negative BSI occured in 71.5% of cases, mainly due to Klebsiella pneumoniae (21.5%), Escherichia coli (16.7%), and Pseudomonas aeruginosa (11.8%). 98.2% of BSI patients received empirical antimicrobial therapy while 58.5% received adequate empirical antibiotic coverage. There was no significant association between adequacy of empirical antibiotic coverage with length of hospital stay (p = 0.149), 48-hours all-cause mortality (p = 0.255), and 28-days all-cause mortality (p = 0.676). Albumin levels < 3.0 g/dL (Adj OR = 5.163; 95% CI = 1.388-19.210; p = 0.014) was an independent 48-hours all-cause prognostic factor of mortality and elevated CRP levels ≥184.4 mg/L (Adj OR = 5.923; 95% CI = 1.387-25.000; p = 0.016) was an independent 28-days all-cause prognostic factor of mortality for solid tumour malignancy patients with BSI. Conclusion: We found that empirical treatment adequacy was not associated with length of hospital stay and mortality among solid tumour malignancy patients with BSI. Hypoalbuminaemia and CRP elevation may be used as prognostic indicators for mortality among the solid tumour malignancy patients with BSI and should be further evaluated with prospective studies of larger sample size.