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Original research
Risk factors for bloodstream infections in gynecological cancer
  1. Laura Franza1,2,
  2. Barbara Costantini3,
  3. Giacomo Corrado3,
  4. Teresa Spanu4,
  5. Marcello Covino1,
  6. Veronica Ojetti1,
  7. Lorena Quagliozzi3,
  8. Antonella Biscione3,
  9. Francesco Taccari2,
  10. Anna Fagotti5,
  11. Giovanni Scambia5 and
  12. Enrica Tamburrini2
  1. 1 Emergency Medicine, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
  2. 2 Department of Infectious Diseases, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
  3. 3 Department for Women's and Children's Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
  4. 4 Institute of Microbiology, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
  5. 5 Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
  1. Correspondence to Dr Giacomo Corrado, Department for Women's and Children's Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio 00168, Italy; giacomo.corrado{at}alice.it

Abstract

Objective Infections are a threat to frail patients as they have a higher risk of developing serious complications from bloodstream pathogens. The aim of this study was to determine which factors can predict or diagnose bloodstream infections in patients with an underlying gynecologic malignancy.

Materials and Methods Between July 2016 and December 2017, 68 patients visiting the emergency room with an underlying gynecologic malignancy were evaluated. Variables concerning underlying disease, invasive procedures, and laboratory and clinical parameters were analyzed. Patients were divided into three groups based on their blood and urine specimens (positive blood specimens, positive urine specimens, and no positive specimens; patients who had both positive blood and urine specimens were included in the group of positive blood specimens). Risk factors for surgical site infections, recent (<30 days) surgery, and chemotherapy were studied separately.

Results 68 patients were included in the analysis. Mean age was 55.6 years (standard deviation 14.1). 44% of patients had ovarian cancer, 35% cervical cancer, 12% endometrial cancer, and 9% had other cancer types. In total, 96% of all patients had undergone surgery. Patients who had been treated with chemotherapy were at a higher risk of developing bloodstream infection (P=0.04; odds ratio (OR)=7.9). C reactive protein, bilirubin, and oxygen saturation (SO2) were significantly different between patients with an underlying infection and those who had none. Only C reactive protein maintained its significance in a linear model, with a cut-off of 180 mg/L (linear regression, P=0.03; OR=4).

Conclusions Chemotherapy is a risk factor for the development of bloodstream infections in patients with an underlying gynecologic malignancy; C reactive protein could be a useful tool in making this diagnosis.

  • sofa score
  • gynecology
  • cancer
  • sepsis

https://doi.org/10.1136/ijgc-2019-000861

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    Footnotes

    • Twitter @annafagottimd

    • Contributors LF and GC conceived the study, carried out the design of the study, participated in the sequence alignment, and drafted the manuscript. BC, TS, MC, and VO participated in the study’s design and coordination, and gave final approval of the version to be published. LQ, AB, and FT carried out the analysis and interpretation of the data and helped draft the manuscript. AF participated in the study’s design and coordination, helped draft the manuscript, and participated in the design. GS and ET gave final approval of the version to be published and revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests The authors are responsible for the content and writing of the paper.

    • Patient consent for publication Not required.

    • Ethics approval Approval to conduct the study was obtained independently from an internal review board at the participating institution.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.