RISK-FACTORS, ETIOLOGY, THERAPY AND OUTCOME IN 123 EPISODES OF BREAKTHROUGH BACTEREMIA AND FUNGEMIA DURING ANTIMICROBIAL PROPHYLAXIS AND THERAPY IN CANCER-PATIENTS

One hundred and twenty-three breakthrough bacteraemias (BB) were defin ed during a 5-year period in a National Cancer Centre, among 9986 admi ssions and a total of 979 bacteraemic episodes analysed, Of 123 bacter aemias in 103 patients, 77 were polymicrobial and 116 of the 323 organ isms isolated were resistant to currently administered antimicrobial a gents, Sixty-seven of the bacteraemic episodes were catheter-associate d, as confirmed by the isolation of the same organisms from both blood and catheter tip. The strains isolated most frequently were coagulase -negative staphylococci (30.5%), corynebacteria (10%), Pseudomonas aer uginosa (10%), Enterococcus faecalis (9%) and viridans streptococci (8 .5%), Gram-positive aerobes accounted for two-thirds of all micro-orga nisms isolated during breakthrough bacteraemic and fungaemic episodes, Polymicrobial episodes were associated more frequently with vascular catheters and neutropenia, and had a less favourable outcome than mono microbial infections, Relapse was associated more frequently with cath eter-related episodes, but the overall mortality, rate was similar and independent of catheter insertion, Breakthrough bacteraemic and funga emic episodes were associated more frequently with acute leukaemia, Ca theter removal, as an independent variable, and modification of antimi crobial therapy were essential for better outcome.