Bloodstream infections in older cancer patients: epidemiology and risk factors for mortality

Abstract

Introduction: Both aging and malignancy are associated with an increased risk of infections, including bloodstream infections. Despite their clinical significance, research concentrating on the epidemiology, outcomes, and risk factors influencing mortality in older cancer patients is still limited. This study aims to examine the epidemiology of bloodstream infections and factors contributing to mortality among older cancer patients.

Methodology: This retrospective cohort study was conducted at Etlik City Hospital from January to December 2023. The subjects included cancer patients aged 65 years and older who had experienced bloodstream infections and received a minimum of 48 hours of antimicrobial therapy. Data, including demographics, clinical features, microbiological findings, and antimicrobial therapy, were collected. Bloodstream infections were categorized as either hospital-acquired or community-acquired infections and further classified by their source.

Results: Among 160 bloodstream infection episodes observed, 68.8% of them occurred in patients with solid tumors, while 31.3% were found in those with hematological malignancies. Hospital-acquired infections comprised 78.8% of the total cases. Mortality was significantly associated with inappropriate initial antimicrobial therapy, carbapenem resistance, and multidrug resistance. Additionally, patients who presented with septic shock and fungal infections had higher mortality rates.

Conclusion: The findings underscore the urgent need for early implementation of appropriate antimicrobial therapy and effective infection control measures. The persistence of multidrug resistance and hospital-acquired infections presents critical challenges in reducing mortality rates among older cancer patients. The development of tailored infection management strategies and robust antimicrobial stewardship programs is essential for enhancing outcomes in cancer patients.