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      Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case–Control Study

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          Abstract

          Introduction

          We aimed to compare the clinical characteristics and outcomes of bloodstream infections (BSI) in cancer patients presenting febrile neutropenia with and without HIV infection, and analyze the prognostic factors for mortality.

          Methods

          BSI episodes in febrile neutropenic patients following chemotherapy were prospectively collected (1997–2018). A case (HIV-infected)–control (non-HIV-infected) sub-analysis was performed (1:2 ratio), matching patients by age, gender, baseline disease, and etiological microorganism.

          Results

          From 1755 BSI episodes in neutropenic cancer patients, 60 (3.4%) occurred in those with HIV. HIV characteristics: 51.7% were men who have sex with men; 58.3% had < 200 CD4; 51.7% had a detectable HIV-1 RNA viral load before the BSI episode; 70.0% met AIDS-defining criteria; and 93.3% were on antiretroviral therapy, with a protease inhibitor-based regimen being the most common (53.0%). HIV-infected patients were younger, more frequently male and more commonly presenting chronic liver disease ( p < 0.001 for all). BSI due to Enterococcus spp. was significantly more frequent among patients with HIV ( p = 0.017) with no differences in other pathogens. HIV-infected patients with cancer presented with shock more frequently ( p = 0.014) and had higher mortality (31.7% vs. 18.1%, p = 0.008). In the case–control analysis, cases (HIV-infected) had chronic liver disease ( p = 0.003) more frequently, whereas acute leukemia ( p = 0.013) and hematopoietic stem-cell transplant ( p = 0.023) were more common among controls. There was a non-significant trend for cases to have higher mortality ( p = 0.084). However, in multivariate analysis, HIV infection was not associated with mortality ( p = 0.196).

          Conclusion

          HIV-infected patients with cancer developing febrile neutropenia and BSI have different epidemiological and clinical profiles, and experience higher mortality. However, HIV infection by itself was not associated with mortality.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40121-021-00445-3.

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          Most cited references 10

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          Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

          This intercontinental study aimed to study gram-negative rod (GNR) resistance in hematopoietic stem cell transplantation (HSCT).
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            Risk of bacteraemia and mortality in patients with haematological malignancies.

            This study examined the association between type of haematological malignancy, risk of bacteraemia and risk of mortality, with emphasis on the impact of bacteraemia type on mortality. A population-based cohort design was used, and all patients aged > or = 15 years with an incident haematological malignancy who were living in North Jutland County, Denmark, during 1992-2002 were included in the study. Among 1666 patients with an incident haematological malignancy, 358 (21%) suffered an episode of bacteraemia during a median follow-up period of 1.1 years (quartile 0.2-3.4) from the date of cancer diagnosis (overall incidence rate of 96/1000 person-years). In comparison to Hodgkin's disease, adjusted incidence rate ratios (IRRs) were 23.3 (95% CI, 10.0-54.5) for acute myeloid leukaemia, 3.8 (95% CI, 1.5-9.3) for multiple myeloma, and 2.2 (95% CI, 0.9-5.1) for non-Hodgkin's lymphoma or chronic lymphatic leukaemia. Overall cumulative 30-day mortality was 32% (95% CI, 27-37), and 90-day mortality was 50% (95% CI, 44-55). In comparison with acute myeloid leukaemia, adjusted mortality rate ratios (MRRs) were close to 1.0 for other haematological malignancies. In comparison to bacteraemia caused by Gram-positive bacteria, adjusted MRRs were 1.0 (95% CI, 0.6-1.5) for Gram-negative bacteraemia, and 1.9 (95% CI, 1.1-3.3) for polymicrobial bacteraemia or fungaemia. Thus, the risk of bacteraemia varied greatly according to the type of malignancy, while mortality rates were similar for these diseases, although dependent on the type of bacteraemia. Polymicrobial bacteraemia or fungaemia was associated with higher mortality.
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              CD4 lymphopenia as a risk factor for febrile neutropenia and early death after cytotoxic chemotherapy in adult patients with cancer.

              Lymphopenia is frequently observed in patients with cancer and correlates with the risk of febrile neutropenia and early death after chemotherapy. The phenotype of the depleted lymphocyte populations was investigated in the current study. Peripheral blood lymphocyte subsets (CD3, CD4, CD8, CD19, CD56) were quantified on Day 1 using fluorescence-activated cell sorting in a prospective study of 213 patients with cancer treated with chemotherapy in a single oncology ward during 12 months. Correlations between lymphocyte phenotype, clinical characteristics, and the risk of febrile neutropenia and early death within 31 days after chemotherapy were investigated in univariate and multivariate analyses. Total lymphocyte count and CD3, CD4, and CD8 lymphocyte subsets were significantly lower in patients who experienced febrile neutropenia. Total lymphocyte count and CD3, CD4, CD8, CD19, and CD56 lymphocyte subsets were significantly lower in patients who died within 31 days after chemotherapy. Using logistic regression, CD4 lymphopenia (< 450/muL; odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.5-5.9) and the dose of chemotherapy (OR = 3,9, 95% CI = 2.0-7.8) were both identified as independent risk factors for febrile neutropenia. Fifty-four percent of patients with both risk factors experienced febrile neutropenia. CD4 lymphocyte count < 450/muL was also an independent risk factor for early death (OR = 7.7, 95% CI = 1.7-35). Thirteen percent of patients with a CD4 lymphocyte count
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                Author and article information

                Contributors
                pedro.puerta84@gmail.com
                jambrosioni@intramed.net
                Journal
                Infect Dis Ther
                Infect Dis Ther
                Infectious Diseases and Therapy
                Springer Healthcare (Cheshire )
                2193-8229
                2193-6382
                11 April 2021
                11 April 2021
                June 2021
                : 10
                : 2
                : 955-970
                Affiliations
                [1 ]GRID grid.410458.c, ISNI 0000 0000 9635 9413, Infectious Diseases Department, , Hospital Clinic-IDIBAPS, ; Carrer de Villarroel 170, 08036 Barcelona, Spain
                [2 ]GRID grid.410458.c, ISNI 0000 0000 9635 9413, Microbiology Department, , Centre Diagnòstic Biomèdic, Hospital Clinic, ; Barcelona, Spain
                [3 ]GRID grid.5841.8, ISNI 0000 0004 1937 0247, ISGlobal, Hospital Clinic, , University of Barcelona, ; Barcelona, Spain
                [4 ]GRID grid.410458.c, ISNI 0000 0000 9635 9413, Hematology Department, , Hospital Clinic-IDIBAPS, ; Barcelona, Spain
                [5 ]GRID grid.5841.8, ISNI 0000 0004 1937 0247, University of Barcelona, ; Barcelona, Spain
                Article
                445
                10.1007/s40121-021-00445-3
                8116456
                33840061
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100013276, Interreg;
                Funded by: FundRef http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;
                Award ID: CM18/00132
                Award ID: FI19/00133
                Award ID: PI18/01061
                Award ID: FIS PI18/01061
                Award Recipient :
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2021

                bacteremia, hiv, multidrug resistance, neutropenia

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