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Authors

M Hamidul Huque (Lead)

R Walton

N Gilroy

S Woolford

L Ryan

Aims

To have a better understanding of the burden of infection in patients receiving myelosuppressive treatment regimens. 

Method

We analysed data obtained by linking population-based, state mandated and routinely collected health records of cancer diagnosis, treatment, co-morbidity and death associated with adult cancer patients (age ≥ 20 years) receiving myelosuppressive chemotherapy in New South Wales during 2006-2007.

Results

A total of 6245 patients were matched across the 4 registries, of which 2175 (35%) had an organism (bacterial or fungal) or site of infection (organism not specified) as a contributory cause of discharge diagnosis. Neutropenia was associated with 871(40%) of all infection-related diagnoses. In general, younger patients, patients with haematological malignancies and recipients of chemotherapy alone (without adjunctive radiotherapy or surgery) were most likely to have neutropenia related infections.  Fever with neutropenia was associated with 85.4% of patients receiving chemotherapy for acute leukaemia or conditioning for blood and marrow transplantation, followed by other haematological cancer diagnoses (29%), lung cancer (16.4%) and breast cancer (13.1%).  E. coli accounted for 360/749 (48%) of coded gram negative infections, and Staphylococcus aureus for 333/758 (44%) of coded gram positive infections. Candida sepsis was coded in 8/26 (30.7%) fungal infections. A higher proportion of patients with neutropenia had device-related infections, whereas pneumonia and urinary tract infections were more common in those with non-neutropenic sepsis.

Implications

Infection is a major cause of preventable morbidity and mortality in cancer patients receiving myelosuppressive chemotherapy.  Understanding the types of infections and their distribution will inform strategies and interventions aimed at improving cancer treatment outcomes. This Australian study, linking data from multiple contemporary cancer and population registries, has enabled a better understanding of the burden of infection in patients receiving myelosuppressive treatment regimens.