-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to describe the clinical aspects of the epidemiology of candidemia and compare the prognostic impact of potential risk factors and the microbiology data of adults and children with cancer. A prospective cohort study enrolling 99 adults and 130 children with candidemia at a tertiary oncology care center in Brazil was undertaken. A total of 229 episodes were analyzed. The overall mortality was higher among adults than in children (37.4% vs. 7.7%, respectively). Univariate analysis revealed significant differences in the risk factors associated with death between both groups. Mortality was similar following fungemia with Candida albicans and all C. non-albicans species. However, significant differences in the interspecies distribution and death rates were observed, mainly among C. glabrata, krusei, and tropicalis species. Multivariate analysis showed comorbidities and neutropenia to be independently associated with mortality in adults, while in children, only comorbidities negatively affected the outcome. Comorbidities were the most important independent prognostic factor in both groups. The inclusion of detailed information about pre-existent illnesses might have a real benefit in studies of candidemia outcome.
European Journal of Clinical Microbiology 07/2008; 27(11):1071-8. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A total of 399 consecutive episodes of bloodstream infections in adult patients with haematologic malignancies and solid tumours were evaluated prospectively over a 26-month period, with the aim of determining the clinical characteristics and the microbiological profile of the patients relative to neutrophil count. The overall 30-day mortality rate was 32% (35% in non-neutropenic patients vs. 26% in neutropenic patients, p=0.05). Main diagnoses were solid tumours (33%) and lymphoma (29%). Most of the episodes of bloodstream infection (58%) occurred in non-neutropenic patients. Acute leukaemia and bone marrow transplantation predominated in the neutropenic group. Non-neutropenic patients tended to be older and to have a higher frequency of solid tumours and advanced or uncontrolled diseases. Indwelling central venous catheters were present in 51% of the episodes, with a predominance of long-term catheters in neutropenic haematologic patients. Concomitant infections were observed more frequently in non-neutropenic patients. There were 1,040 noninfectious comorbid conditions, most of which were present in non-neutropenic patients. The causative pathogens were predominantly gram-negative bacilli (56%). Escherichia coli and Klebsiella pneumoniae were isolated more frequently from neutropenic patients, while Staphylococcus aureus and Acinetobacter spp. were more frequent in non-neutropenic patients. Seventy-four percent of the episodes of candidaemia occurred in patients with central venous catheters, with non-albicans strains predominating. The results of this study highlight the heterogeneity of cancer patients with bloodstream infections and the value of stratifying risk factors and aetiologic agents according to neutrophil count.
European Journal of Clinical Microbiology 02/2006; 25(1):1-7. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to describe the epidemiology and microbiology of bloodstream infections (BSIs) among adult surgical cancer patients and to determine independent factors that influence in-hospital mortality. The study enrolled 112 consecutive episodes of BSIs in adult surgical cancer patients during a 26-month period. The median age of the patients was 64.5 years, and crude in-hospital mortality was 19.6%. The median time from surgery to the index blood culture was 11 days and from index blood culture to death was 4.5 days. Seventy-five percent of the patients had an advanced tumor disease, 36.6% were under intensive care, and 68.7% had a central venous catheter in place at the time the bloodstream infection was diagnosed. Associated infected sites were present in 57.1% of the episodes. There were 328 noninfectious co-morbid conditions. Poor performance status, weight loss, hypoalbuminemia, and ventilatory support accounted for 67.4% of them. There was a predominance of aerobic gram-negative bacilli (62%), followed by gram-positive cocci (26.6%) and fungi (9.3%). The observed mortality rates associated with these organism groups were similar (23.6% vs 15% vs 28.6%, respectively; P=0.44). The most frequent organisms were Enterobacter spp., coagulase-negative staphylococci, Klebsiella spp., Acinetobacter spp., and fungi. Nonfermentative strains predominated in patients with catheters. Thirty-five (30.2%) pathogens were considered resistant. There was no significant difference in the mortality rate between patients with resistant and those with nonresistant organisms (20% vs 26%, respectively; P=0.49). Logistic regression analysis showed > or = 4 co-morbid conditions, advanced tumor, thoracic surgery, catheter retention, and pulmonary infiltrates as independent predictors of mortality. Medical and infection control measures addressing certain variables amenable to intervention might reduce the negative impact of postoperative infectious morbidity and mortality of BSIs in adult surgical cancer patients.
European Journal of Clinical Microbiology 09/2004; 23(8):596-602. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A prospective clinical and microbiological surveillance study was conducted during a 26-month period to evaluate consecutive malignancy or post-bone marrow transplant patients with positive blood cultures. The study included 859 episodes of bloodstream infection (BSI) in 719 patients. There were 6.9 BSI episodes/1000 patient-days. Overall mortality was 25%. The median age of patients was 43 years, with 71% of episodes occurring in patients aged > 18 years. Patients with underlying haematology malignancies accounted for 38.2% of the episodes. An indwelling central vein catheter was present in 61% of episodes. BSI origin was unknown in 27% of episodes, associated with other sites in 49.6%, and catheter-related in 23.4%. There were 638 concomitant infection sites, of which the most common were pulmonary (28.4%), urinary tract (14.8%), and non-surgical skin or soft tissue (9.7%). In total, 1039 microorganisms were isolated within 48 h of the first blood culture, of which Gram-negative bacilli accounted for 56%. Among Klebsiella pneumoniae and Escherichia coli isolates, 37.8% and 8.9%, respectively, produced extended-spectrum beta-lactamases. High rates of ceftazidime resistance were detected among Acinetobacter spp. (40%) and Enterobacter spp. (51.2%). E. coli and K. pneumoniae were isolated frequently from haematology patients, and Enterobacter spp. from solid tumour patients. E. coli, K. pneumoniae and Pseudomonas aeruginosa were isolated more often from neutropenic than from non-neutropenic patients. Oxacillin resistance was detected in 18.7% of Staphylococcus aureus isolates. It was concluded that continuous multidisciplinary surveillance of BSI is warranted in this high-risk group of patients in order to develop strategies for antimicrobial resistance control and treatment of infectious complications.
Clinical Microbiology and Infection 06/2004; 10(6):542-9. · 4.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Bloodstream infections (BSIs) have an important impact on the outcome of cancer patients. A prospective cohort study was undertaken at a referral cancer center in order to describe the clinical and microbiological characteristics of patients with hematologic malignancies and BSIs and to identify independent predictors associated with mortality. The study enrolled 110 consecutive BSI episodes during an 18-month period. Patients were monitored for 30 days after the last positive blood culture. There were 10.24 BSI episodes per 1,000 patient-days. The median age of the patients was 25 years. Most patients had acute leukemia ( n=72). The origin of the BSI was unknown in 43.6% of the episodes and was associated with known sites in 32.7%. There were 58 concomitant infectious sites (lungs, 43%, and soft tissue, 22.4%) and 195 noninfectious comorbid factors (poor performance status, 30.2%; undernourishment, 14.3%). The median neutrophil count was 215 cells/mm(3). Indwelling catheters were present in 70% of the episodes. The majority of isolates obtained within the first 48 h of the BSI episode (61%) were gram-negative rods. Overall mortality was 24.5%. Multivariate analysis using logistic regression showed relapsed leukemia, poor performance status, recent weight loss, and ventilatory failure requiring ventilatory support as independent predictors of mortality. Hematologic cancer patients with BSIs should be regarded as a distinct group of patients at high risk of death. The knowledge of variables amenable to intervention would help diminish or prevent serious medical complications.
European Journal of Clinical Microbiology 04/2003; 22(3):137-43. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cancer patients are at unusually high risk for developing bloodstream infections (BSI), which are a major cause of in-hospital morbidity and mortality.
To describe the epidemiological characteristics and the etiology of BSI in cancer patients.
Descriptive study.
Terciary Oncology Care Center.
During a 24-month period all hospitalized patients with clinically significant BSI were evaluated in relation to several clinical and demographic factors.
The study enrolled 435 episodes of BSI (349 patients). The majority of the episodes occurred among non-neutropenic patients (58.6%) and in those younger than 40 years (58.2%). There was a higher occurrence of unimicrobial infections (74.9%), nosocomial episodes (68.3%) and of those of undetermined origin (52.8%). Central venous catheters (CVC) were present in 63.2% of the episodes. Overall, the commonest isolates from blood in patients with hematology diseases and solid tumors were staphylococci (32% and 34.7%, respectively). There were 70 episodes of fungemia with a predominance of Candida albicans organisms (50.6%). Fungi were identified in 52.5% of persistent BSI and in 91.4% of patients with CVC. Gram-negative bacilli prompted the CVC removal in 45.5% of the episodes. Oxacillin resistance was detected in 26.3% of Staphylococcus aureus isolates and in 61.8% of coagulase-negative Staphylococcus. Vancomycin-resistant enterococci were not observed. Initial empirical antimicrobial therapy was considered appropriate in 60.5% of the cases.
The identification of the microbiology profile of BSI and the recognition of possible risk factors in high-risk cancer patients may help in planning and conducting more effective infection control and preventive measures, and may also allow further analytical studies for reducing severe infectious complications in such groups of patients.
Sao Paulo Medical Journal 10/2000; 118(5):131-8. · 0.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A multicentric randomized trial was undertaken to compare the toxicity of amphotericin B in 5% dextrose with that of amphotericin B in a fat emulsion (Intralipid) in cancer patients. Group 1 (n = 33) received amphotericin B diluted in 5% dextrose with premedication consisting of promethazine plus an antipyretic. Group 2 (n = 28) received amphotericin B diluted in 20% Intralipid without premedication. Amphotericin B was infused daily at a dose of 1 mg/kg of body weight over a 1-h period to members of both groups for empirical antifungal therapy (in neutropenic patients) or for the treatment of documented fungal infections. The majority of patients (80%) received empirical amphotericin B treatment. The two groups were comparable with regard to age, gender, underlying disease, and the following baseline characteristics: use of other nephrotoxic drugs and serum levels of potassium and creatinine. The median cumulative doses of amphotericin B were 240 mg in group 1 and 245 mg in group 2 (P = 0.73). Acute adverse events occurred in 88% of patients in group 1 and in 71% of those in group 2 (P = 0.11). Forty percent of the infusions in group 1 were associated with fever, compared to 23% in group 2 (P < 0.0001). In addition, patients in group 2 required less meperidine for the control of acute adverse events (P = 0.008), and fewer members of this group presented with hypokalemia (P = 0.004) or rigors (P < 0.0001). There was no difference in the proportions of patients with nephrotoxicity (P = 0.44). The success rates of empirical antifungal treatment were similar in the two groups (P = 0.9). Amphotericin B diluted in a lipid emulsion seems to be associated with a smaller number of acute adverse events and fewer cases of hypokalemia than amphotericin B diluted in 5% dextrose.
Antimicrobial Agents and Chemotherapy 06/1999; 43(6):1445-8. · 4.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Bacillus species were recovered from the blood cultures of 39 oncology patients over 14 weeks. A matched case-control study showed a strong association of Bacillus species bacteremia with use of calcium gluconate solution (odds ratio=25.0) and of central venous lines (odds ratio=8.8). Stopping use of the implicated calcium gluconate vials controlled the outbreak.
Infection Control and Hospital Epidemiology 12/1998; 19(11):856-8. · 3.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A hospital-based matched case-control study was conducted in order to identify risk factors for the development of bloodstream infections in adult hospitalized patients. Between January 1993 and December 1994, 264 episodes of bloodstream infection were evaluated. Significant variables identified by univariate analysis were included in a multivariate model that showed that central venous catheter [odds ratio (OR), 6.71], poor performance status (OR, 3.40), weight loss (OR, 2.47), hematologic diseases (OR, 2.24), and previous antimicrobial therapy (OR, 2.12) independently influenced the outcome. The knowledge of modifiable risk factors is useful in the development of strategies that may contribute to the prevention of bloodstream infections.
European Journal of Clinical Microbiology 09/1998; 17(8):587-90. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In order to identify prognostic factors for death among cancer patients with fungemia, an 18-month survey of fungemia in patients with cancer was undertaken in three hospitals in Rio de Janeiro. For the assessment of risk factors for death, the following variables were analyzed: age; gender; underlying cancer; last treatment for the underlying disease; previous surgery; use of antibiotics, antifungal agents, steroids, or total parenteral nutrition; use of a central venous catheter; chemotherapy; radiotherapy; presence and duration of neutropenia; etiologic agent of the fungemia; treatment of the fungemia; clinical manifestations; and performance status (Karnofsky score) on the day of the positive blood culture. In multivariate analysis, the variables associated with an increased risk for death were older age, persistent neutropenia, and low performance status. Identifying risk factors for death may help to define a group-risk patients for whom new therapeutic options should be tried.
Clinical Infectious Diseases 08/1998; 27(1):107-11. · 9.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Several studies have shown that surgical site infections represent most hospital-acquired infections, with the major impact being on average hospital stay and cost of hospitalization.
To develop a risk model for prediction of surgical site infections in cancer patients undergoing operative procedures and identify those with high probability of infection we performed a prospective cohort study in a tertiary cancer care hospital in Rio de Janeiro, Brazil. Risk factors were studied in single and multivariate analyses.
Over a 24-month period, 1205 patients underwent operations for malignant disease. The overall surgical site infection rate was 17.3%. A multivariate stepwise logistic regression model identified six independent predictive risk factors: contaminated and infected operations, surgical duration greater than 280 minutes, male sex, prior radiotherapy, American Society of Anesthesiology class III to V, and antimicrobial prophylaxis not according to protocol. On the basis of individual risk scores, two groups of patients were identified: a low-risk (score < or = 8; surgical site infection rate 10%) and a high-risk group (score > or = 9; surgical site infection rate 33.6%; relative risk 3.4; 95% confidence interval 2.6 to 4.4).
The oncology risk model allowed for the identification of a high-risk score group of patients and implementation of a more efficient and selective intervention program.
American Journal of Infection Control 06/1998; 26(3):217-23. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to characterize the epidemiology of candidemia in cancer patients in the city of Rio de Janeiro, Brazil. An 18-month survey of fungemia in patients with cancer was undertaken in three Hospitals in Rio de Janeiro. Forty-three episodes of candidemia were identified in 43 patients, 43 of which were episodes of candidemia; in ten case the strains were not available for further identification of species and were excluded from this analysis. The overall distribution of fungi causing fungemia was: Candida albicans (5), Candida tropicalis (16), Candida parapsilosis (6), Candida guilliermondii (4), Candida lusitaniae (1) and Candida stellatoidea (1). Antifungal prophylaxis had been administered before the episode of fungemia in only six patients (18.2%): oral itraconazole in three patients and oral nistatin, low dose intravenous amphotericin B and oral fluconazole in one patient each. There was no difference in the presence of risk factors, clinical characteristics or in the outcome between albicans and non-albicans species, nor between Candida tropicalis and other non-albicans species. There was a clear predominance of non-albicans species, regardless of the underlying disease, antifungal prophylaxis or the presence of neutropenia.
Mycopathologia 02/1998; 141(2):65-8. · 1.65 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Treatment of cancer has contributed to a growing number of immunocompromised patients with life-threatening nosocomial infections (NI). High mortality with considerable cost is observed when they are admitted to the intensive care unit (ICU). Few studies on infection control and surveillance have been undertaken in this population group.
All patients treated at a six-bed medical-surgical oncology ICU for > 48 hours were prospectively observed for the development of an NI and the influence of device utilization on infection rates. The analysis used the standard definitions of the National Nosocomial Infection Surveillance System Intensive Care Unit surveillance component.
From September 1993 through November 1995, 370 infections occurred in 623 patients during 4034 patient-days, for an overall rate of 50.0 per 100 patients or 91.7 per 1000 patient-days. Pneumonia (28.9%), urinary tract infections (25.6%), and bloodstream infections (24.1%) were the main types of infection. The most common microorganisms isolated were Enterobacteriaceae (29.7%), fungi (22.2%), and Pseudomonas aeruginosa (13.2%). The median device utilization ratios were 0.63, 0.83, and 0.86 for ventilator, indwelling urinary catheter, and central venous catheter, respectively. The highest median device-specific associated infection rate was 41.7 for ventilator. The median for the average length of stay was 8.8 days, and the average severity of illness score was 4.0. There was a strong positive correlation between the overall NI patient rate and device utilization (r = 0.56, p < 0.01), average severity of illness score (r = 0.54, p < 0.01), and average length of stay (r = 0.67, p < 0.01). No correlations were statistically significant when patient-days were used in the denominator. Among the devices only the number of central venous catheter days was significantly correlated with infections (r = 0.51, p = 0.01). The NI patient-day rates were progressively higher the longer the patients stayed in the ICU.
The high rates reported in this study may reflect a combination of several factors related to the underlying illness, neutrophil count, and exposure to invasive procedures. The adjusted infection rates described here provide specific surveillance data for further interhospital comparisons and also to assess the influence of invasive medical interventions, allowing the implementation of preventable measures to control infections.
American Journal of Infection Control 12/1997; 25(6):458-62. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Yeasts belonging to the genus Hansenula are rarely encountered as the cause of infection in clinical practice. A wide spectrum of infections caused by these fungi can be seen, ranging from asymptomatic fungaemia to severe disease. We describe an outbreak of 24 cases of infection due to H. anomala in an oncological hospital in Rio de Janeiro, Brazil. The median age of the patients was 11 years, of whom 54.2% were female; 91.7% of the Hansenula fungaemia occurred in the haematology unit. The most frequent primary disease diagnosis was leukaemia (62.5%), and all of those infected had had a central venous catheter or peripheral venous catheter and had been treated previously with broad-spectrum antibiotics. Numerous other risk factors were observed in our cases: previous use of steroids, chemotherapy, radiation therapy and neutropenia (data not shown). No deaths could be attributed to Hansenula.
Mycoses 11/1997; 40(5-6):193-6. · 2.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Yeasts belonging to the genus Hansenula are rarely encountered as the cause of infection in clinical practice. A wide spectrum of infections caused by these fungi can be seen, ranging from asymptomatic fungaemia to severe disease. We describe an outbreak of 24 cases of infection due to H. anomala in an oncological hospital in Rio de Janeiro, Brazil. The median age of the patients was 11 years of whom 54.2% were female; 91.7% of the Hansenula fungaemia occurred in the haematology unit. The most frequent primary disease diagnosis was leukaemia (62.5%), and all of those infected had had a central venous catheter or peripheral venous catheter and had been treated previously with broad-spectrum antibiotics. Numerous other risk factors were observed in our cases: previous use of steroids, chemotherapy, radiation therapy and neutropenia (data not shown). No deaths could be attributed to Hansenula.Zusammenfassung. Hefen der Gattung Hansenula werden selten als Mykoseerreger beobachtet. Wir berichten über den Ausbruch von 24 H. anomala-Infektionen in einem onkologischen Krankenhaus in Rio de Janeiro, Brasilien. Das durchschnittliche Alter der Patienten war 11 Jahre. 92% der Hansenula-Fungmie-Flle traten in der Hmatologie-Einheit auf. Bei den meisten Patienten (63%) war Leukmie die Grundkrankheit, und alle Infizierten hatten einen zentralvenösen oder periphervenösen Verweilkatheter und wurden mit Breitspektrumantibiotika behandelt. Weitere Prdispositionsfaktoren waren Steroidbehandlung, antileukmische Chemotherapie, Strahlentherapie und Neutropenie. Hansenula-bedingte Todesflle wurden nicht beobachtet.
Mycoses 09/1997; 40(5‐6):193 - 196. · 2.25 Impact Factor
-
Clinical Infectious Diseases 03/1997; 24(2):275-6. · 9.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The emergence of nosocomial infection as a serious complication after intraabdominal operations for cancer prompted us to identify major independent risk factors associated with postoperative infection.
Risk factors were studied in single and multivariate analyses. Variables considered were remote infection, antimicrobial prophylaxis, preoperative stay, chemotherapy, radiotherapy, weight loss, elective versus emergency operation, wound class, duration of operation, drains, sex, age, and physical status.
During 24 months, 236 patients were entered in the study. The overall postoperative infection rate was 45.7%; the surgical site infection rate was 22.4%. Multivariate analysis identified three independent variables: duration of operation longer than 5 hours (odds ratio 6.41, 95% confidence interval 3.28 to 12.54), presence of remote infection at operation (odds ratio 3.76, 95% confidence interval 1.76 to 8.03), and preoperative stay longer than 22 days (odds ratio 2.03, 95% confidence interval 1.04 to 3.95). The relative risk of infection increased from 3.0 when one risk factor was present to 7.3 when all three risk factors were present.
The predictive power of our final multivariate risk index clearly groups these patients according to differing risk for postoperative infection. This classification contributes substantially to the effectiveness of infection control strategies to prevent the occurrence of postoperative infection in the high-risk population of patients with cancer.
American Journal of Infection Control 03/1996; 24(1):1-6. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aminoglycoside-containing combination therapy has been the standard empirical approach for febrile neutropenic cancer patients. With the advent of the broad-spectrum oral fluoroquinolones, it is now possible to evaluate an initial empirical alternative therapy. A prospective randomized study was conducted comparing oral ciprofloxacin plus penicillin V (group A) with amikacin plus carbenicillin or ceftazidime (group B). Main criteria for eligibility were febrile patients with solid tumor or nonlymphoblastic lymphoma, a Zubrod PS equal to 1 or 2, no diarrhea, mucositis, or long-term central venous catheter. A total of 108 consecutive neutropenic febrile episodes were randomized (5 exclusions); 55 episodes were assigned to group A and 48 to group B. Most febrile episodes were of unknown origin. There were 10 microbiologically documented episodes with two cases of bacteremia. Both regimens were well tolerated. Oral regimen was substantially cheaper than parenteral regimen. Treatment success without regimen modification was 94.5% for group A and 93.8% for group B (p = .86; CI -0.08-0.10). Oral therapy with ciprofloxacin and penicillin V is a safe alternative to standard parenteral therapy in this low-risk group of neutropenic patients, with unquestionable cost containment.
American Journal of Clinical Oncology 11/1995; 18(5):429-35. · 2.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fusarium infection is increasingly reported in immunocompromised patients. The role of central venous catheters as potential portals of entry for Fusarium is possibly underestimated. Four cases of catheter-related fusarial infection in children with acute leukemia or a solid tumor are described. These patients had an excellent response to removal of the central venous catheter and treatment with amphotericin B.
European Journal of Clinical Microbiology 09/1995; 14(8):697-9. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Oxacillin-resistant Staphylococcus aureus (ORSA) infection is an important cause of hospital morbidity and mortality. The objective of this study was to identify the main factors associated with death in patients colonized or infected with Staphylococcus aureus in a cancer center. A matched-pair case-control study enrolled all patients infected or colonized with ORSA (cases) admitted to the Hospital do Câncer in Rio de Janeiro from 01/01/1992 to 12/31/1994. A control was defined as a patient hospitalized during the same period as the case-patients and colonized or infected with oxacillin-susceptible Staphylococcus aureus (OSSA). The study enrolled 95 cases and 95 controls. Patient distribution was similar for the two groups (p > or = 0.05) with respect to gender, underlying diseases, hospital transfer, prior infection, age, temperature, heart and respiratory rates, neutrophil count, and duration of hospitalization. Univariate analysis of putative risk factors associated with mortality showed the following significant variables: admission to the intensive care unit (ICU), presence of bacteremia, use of central venous catheter (CVC), ORSA colonization or infection, pneumonia, use of urinary catheter, primary lung infection, prior use of antibiotics, mucositis, and absence of cutaneous abscesses. Multivariate analysis showed a strong association between mortality and the following independent variables: admission to ICU (OR [odds ratio] = 7.2), presence of Staphylococcus bacteremia (OR = 6.8), presence of CVC (OR = 5.3), and isolation of ORSA (OR = 2.7). The study suggests a higher virulence of ORSA in comparison to OSSA in cancer patients.
Revista do Hospital das Clínicas 54(2):47-52.
