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Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome

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Abstract

Objective

To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies.

Design and setting

Prospective observational study in a 14-bed medical ICU at a tertiary university hospital.

Patients

A total of 172 consecutive patients with hematological malignancies admitted to the ICU for a life-threatening complication over a 4-year period were categorized into three main groups according to their admission diagnosis (documented bacterial infection, clinically suspected bacterial infection, nonbacterial complications) by an independent panel of three physicians blinded to the patient’s outcome and C-reactive protein levels.

Results

In-hospital and 6-months mortality rates in documented bacterial infection (n=42), clinically suspected bacterial infection (n=40) vs. nonbacterial complications (n=90) were 50.0% and 42.5% vs. 65.6% (p=0.09 and 0.02) and 56.1% and 48.7% vs. 72.1% (p=0.11 and 0.02), respectively. Median baseline C-reactive protein levels in the first two groups were 23 mg/dl and 21.5 mg/dl vs. 10.7 mg/dl (p<0.001 and p=0.001) respectively. After adjustment for the severity of critical and underlying hematological illness and the duration of hospitalization before admission documented (OR 0.20; 95% CI 0.06–0.62, p=0.006) and clinically suspected bacterial infection (OR 0.18; 95% CI 0.06–0.53, p=0.002) were associated with a more favorable outcome than nonbacterial complications.

Conclusions

Severely ill patients with hematological malignancies admitted to the ICU because of documented or clinically suspected bacterial infection have a better outcome than those admitted with nonbacterial complications. These patients should receive advanced life-supporting therapy for an appropriate period of time

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References

  1. Löwenberg B, Downing JR, Burnett A (1999) Acute myeloid leukaemia. N Engl J Med 341:1051–1062

    Google Scholar 

  2. Bennett CL, JL Armitage JL, Vose JM, Bierman PJ, Armitage JO, Anderson JR (1995) Costs of care and outcomes for high-dose therapy and autologous transplantation for lymphoid malignancies: results from the University of Nebraska 1987 through 1991. J Clin Oncol 13:969–973

    Google Scholar 

  3. Sculier JP, Markiewicz E (1995) Intensive care in anticancer centres: an international inquiry. Support Care Cancer 3:130–134

    Google Scholar 

  4. Schuster DP, Marion JM (1982) Precedents for meaningful recovery during treatment in a Medical Intensive Care Unit. Outcome in patients with hematologic malignancy. Am J Med 75:402–408

    Google Scholar 

  5. Lloyd-Thomas AR, Wright I, Lister TA, Hinds CJ (1988) Prognosis of patients receiving intensive care for life-threatening medical complications of haematological malignancy. BMJ 296:1025–1029

    CAS  PubMed  Google Scholar 

  6. Brunet F, Lanore JJ, Dhainaut JF, Dreyfus F, Vaxelaire JF, Nouira S, Giraud T, Armaganidis A, Monsallier JF (1990) Is intensive care justified for patients with haematological malignancies? Intensive Care Med 16:291–297

    CAS  PubMed  Google Scholar 

  7. Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B (1996) Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. Eur J Cancer 33:1031–1037

    Google Scholar 

  8. Groeger JS, Lemeshow S, Price K, Nierman DM, White P, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the Intensive Care Unit: Probability of mortality model. J Clin Oncol 16:761–770

    CAS  PubMed  Google Scholar 

  9. Groeger JS, White P Jr, Nierman DM, Glassman J, Shi WJ, Horak D, Price K (1999) Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 17:991–997

    Google Scholar 

  10. Faber-Langendoen K, Caplan AL, McGlave PB (1993) Survival of adult bone marrow transplant patients receiving mechanical ventilation: a case for restricted use. Bone Marrow Transplant 12:501–507

    Google Scholar 

  11. Price KJ, Thall PF, Kish SK, Shannon VR, Andersson BS (1998) Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit. Am J Respir Crit Care Med 158:876–884

    CAS  PubMed  Google Scholar 

  12. Bach PB, Schrag D, Nieman DM, Horak D, White P, Young JW, Groeger JS (2001) Identification of poor prognostic features among patients requiring mechanical ventilation after hematopoietic stem cell transplantation. Blood 98:3234–3240

    Google Scholar 

  13. Schapira DV, Studnicki J, Bradham DD, Wolff P, Jarett A (1993) Intensive care, survival, and expense of treating critically ill cancer patients. JAMA 269:783–786

    Article  Google Scholar 

  14. Rubenfeld GD, Crawford SW (1996) Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med 8:625–633

    Google Scholar 

  15. Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand JP, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401

    CAS  PubMed  Google Scholar 

  16. Azoulay E, Albertti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525

    Article  CAS  PubMed  Google Scholar 

  17. Larché J, Azouley E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29:1688–1695

    Google Scholar 

  18. Staudinger T, Stoiser B, Müllner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kolfer J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the Intensive care Unit. Crit Care Med 28:1322–1328

    Article  CAS  PubMed  Google Scholar 

  19. Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31:104–112

    Article  PubMed  Google Scholar 

  20. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487

    Google Scholar 

  21. Depuydt PO, Benoit DD, Vandewoude K, Decruyenaere J, Colardyn F (2004) Outcome in non-invasively and invasively ventilated hematologic patients with acute respiratory failure. Chest 126:1299–1306

    Google Scholar 

  22. Benoit D, Depuydt P, Vandewoude K (2004) Bacterial infection. Crit Care Med 32:207–208

    Google Scholar 

  23. Bartlett JG, Breiman RF, Mandell LA, File Jr TM (1998) Guidelines from the Infectious Diseases Society of America. Community-acquired pneumonia in adults: guidelines for management. Clin Infect Dis 26:811–838

    Google Scholar 

  24. Hughes WT, Amstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo EA, Rolston KVI, Shenep JL, Young LS (2002) 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  25. Sickles EA, Greene WH, Wiernick PH (1975) Clinical presentation of infection in granulocytopenic patients. Arch Intern Med 135:715–719

    Google Scholar 

  26. Schiel A, Hebart H, Kern WV, Kiehl MG, Sölch JP, Wilhelm S, Ostermann H (2003) Sepsis in neutropenia. Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 85 [Supp 2]:S158–S166

  27. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit care Med 20:864–874

    PubMed  Google Scholar 

  28. Santolaya ME, Alvarez AM, Becker A, Cofré J, Enriquez N, O’Ryan M, Paya E, Pilorget J, Salgado C, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M (2001) Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol 19:3415–3421

    CAS  PubMed  Google Scholar 

  29. Ascioglu S, de Pauw B, Bennett JE, Bille J, Crokaert F. Denning DW, Donelly JP, Edwards JE, Erjavec Z, Fiere D, Lortholary O, Maertens J, Meis JF, Patterson JF, Ritter J, Selleslag D, Shah PM, Stevens DA, Walsh TJ, On behalf of the invasive fungal infections cooperative group of the European Organisation for Research and Treatment of Cancer and Mycosis Study Group of the National Institute of Allergy and Infectious Diseases (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14

    Article  CAS  PubMed  Google Scholar 

  30. Hosmer DW, Lemeshow S (2000) Model-building strategies and methods for logistic regression. In: Applied logistic regression, 2nd edn. Wiley Interscience, pp 97–116

  31. Alberti C, Brun-Buisson C, Buchardi H, Martin C, Goodman S, Artigas A, Sicignano A, Palazzo M, Moreno R, Boulmé R, Lepage E, Le Gall JR (2002) Epidemiology of sepsis and infection in ICU patients from an international multicenter cohort study. Intensive Care Med 28:108–121

    PubMed  Google Scholar 

  32. Carratalà J, Rosón B, Fernández-Sevilla A, Alcaide F, Gudiol F. Bacteremic pneumonia in neutropenic patients with cancer (1998) Causes, empirical antibiotic therapy, and outcome. Arch Intern Med 158:868–872

    Google Scholar 

  33. Chatzinikolaou I, Abi-Said D, Bodey GP, Rolston KVI, Tarrand JJ, Samonis G (2000) Recent experience with Pseudomonas aeruginosa bacteremia in patients with cancer. Retrospective analysis of 245 episodes. Arch Intern Med 160:501–509

    Google Scholar 

  34. Gruson D, Hilbert G, Portel L, Boiron JM, Bebear CM, Vargas F, Bebear C, Reiffers J, Gbikpi-Benissan G, Cardinaud JP (1999) Severe respiratory failure requiring ICU admission in bone marrow transplant recipients. Eur Respir J 13:883–887

    Google Scholar 

  35. Dunagan DP, Baker AM, Hurd DD, Haponik EF (1997) Bronchoscopic evaluation of pulmonary infiltrates following bone marrow transplantation. Chest 111:135–141

    Google Scholar 

  36. Ewig S, Glasmacher A, Ulrich B, Wilhelm K, Schafer H, Nachtsheim KH (1998) Pulmonary infiltrates in neutropenic patients with acute leukemia during chemotherapy. Outcome and prognostic factors. Chest 114:444–451

    Google Scholar 

  37. Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C, Allery A, Pigneux A, Gbikpi-Benissan G, Cardinaud JP (2000) Utility of fiberbroncoscopy in neutropenic patients admitted to the Intensive care unit with pulmonary infiltrates. Crit Care Med 28:2224–2230

    Google Scholar 

  38. Benoit D, Decruyenaere J, Peleman R, Depuydt P, Vandewoude K, Colardyn F (2002) Outcome in critically ill hematologic cancer patients: impact of bacterial infection. Intensive Care Med [Suppl l]:S115

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Acknowledgements

We are indebted to Carine Van Maris for helping to collect the data. None of authors of this contribution received any commercial benefit from these results or had other associations that might represent a conflict of interest. This research was presented in part at the 15th Meeting of the European Society of Intensive Care Medicine, Barcelona, 29 September–1 October 2002 [38]

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Correspondence to Dominique D. Benoit.

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Benoit, D.D., Depuydt, P.O., Peleman, R.A. et al. Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome. Intensive Care Med 31, 934–942 (2005). https://doi.org/10.1007/s00134-005-2599-z

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