Hospital-acquired bloodstream infections in cancer patients: current knowledge and future directions

Cancer patients experience higher rates of preventable harm from hospital acquired bloodstream infection (haBSI) and central line associated bloodstream infections (CLABSI) than the general hospital population. Prevention of haBSI and CLABSI in cancer patients is an urgent priority and requires standardised surveillance and reporting efforts.The application of haBSI and CLABSI definitions, classification systems and surveillance strategies for cancer patients is complex and there is wide variation in clinical practice. Existing systems were not explicitly designed for cancer patients, and have different strengths and weaknesses in the cancer setting. For these reasons, epidemiological estimates of haBSI and CLABSI in cancer patients also require careful interpretation. This complexity can be a barrier to identifying appropriate targets for intervention and reducing preventable harm.This review provides an overview of key concepts and challenges in haBSI surveillance and prevention specific to patients with cancer. We summarise strengths and weaknesses of commonly used surveillance definitions and denominators in the setting of cancer care; existing surveillance practice; epidemiology of haBSI and CLABSI; prevention strategies; and current knowledge gaps.A global collaborative effort to harmonise surveillance of hospital acquired infections in cancer patients would be invaluable to improve the accuracy and utility of existing data, advance efforts to prevent hospital-acquired infection, and improve patient safety.