PURPOSE\nCancer is associated with an increased risk of acquiring bloodstream infection (BSIs). Most knowledge on pathogens and outcome are derived from specialised cancer centres. We here sought... Show morePURPOSE\nCancer is associated with an increased risk of acquiring bloodstream infection (BSIs). Most knowledge on pathogens and outcome are derived from specialised cancer centres. We here sought to compare causative micro-organisms in BSIs in patients with or without cancer in a 600-bed teaching community hospital.\nMETHODS\nWe analysed all positive blood cultures from adult patients between January 2005 and January 2011.\nRESULTS\nA total of 4,918 episodes of BSI occurred in 2,891 patients, of whom 13.4% had a diagnosis of cancer (85.5% with a solid tumour). In both patient groups, Gram-positive isolates were more prevalent (58.7 and 61.4% in patients with and without cancer, respectively) than Gram-negative isolates (31.8 and 32.3%, respectively). Amongst Gram-positive organisms, coagulase-negative staphylococci, Staphylococcus aureus and enterococci were the most frequently isolated in both patient groups; in cancer patients, twice as many BSIs were caused by Enterococcus faecalis and E. faecium. Amongst Gram-negative organisms, Escherichia coli was the most common isolate; in cancer patients, twice as many BSIs were caused by Pseudomonas aeruginosa and Enterobacter cloacae. Yeasts were grown from 3.0% of blood cultures from cancer patients compared to 1.5% of cultures from non-cancer patients. Cancer patients had a 90-day mortality of 35.8% following BSI compared to 23.5% in patients without cancer.\nCONCLUSION\nThese data demonstrate distinct BSI pathogens and impaired outcomes in patients with cancer in the setting of a large community teaching hospital. Show less
Bos, M.M.E.M.; Bakhshi-Raiez, F.; Dekker, J.W.T.; Keizer, N.F. de; Jonge, E. de 2013
BACKGROUND\nPostoperative care for major elective cancer surgery is frequently provided on the Intensive Care Unit (ICU).\nOBJECTIVE\nTo analyze the characteristics and outcome of patients after... Show moreBACKGROUND\nPostoperative care for major elective cancer surgery is frequently provided on the Intensive Care Unit (ICU).\nOBJECTIVE\nTo analyze the characteristics and outcome of patients after ICU admission following elective surgery for different cancer diagnoses.\nMETHODS\nWe analyzed all ICU admissions following elective cancer surgery in the Netherlands collected in the National Intensive Care Evaluation registry between January 2007 and January 2012.\nRESULTS\n28,973 patients (9.0% of all ICU admissions; 40% female) were admitted to the ICU after elective cancer surgery. Of these admissions 77% were planned; in 23% of cases the decision for ICU admission was made during or directly after surgery. The most frequent malignancies were colorectal cancer (25.6%), lung cancer (18.5%) and tumors of the central nervous system (14.3%). Mechanical ventilation was necessary in 24.8% of all patients, most frequently after surgery for esophageal (62.5%) and head and neck cancer (50.2%); 20.7% of patients were treated with vasopressors in the acute postoperative phase, in particular after surgery for esophageal cancer (41.8%). The median length of stay on the ICU was 0.9 days (interquartile ranges [IQR] 0.8-1.5); surgery for esophageal cancer was associated with the longest ICU length of stay (median 2.0 days) with the largest variation (IQR 1.0-4.8 days). ICU mortality was 1.4%; surgery for gastrointestinal cancer was associated with the highest ICU mortality (colorectal cancer 2.2%, pancreatico-cholangiocarcinoma 2.0%).\nCONCLUSION\nElective cancer surgery represents a significant part of all ICU admissions, with a short length of stay and low mortality. Show less
The care for acute complications occurring in cancer patients has changed dramatically in recent decades, not only for direct post-operative care following major cancer surgery, but also for cancer... Show moreThe care for acute complications occurring in cancer patients has changed dramatically in recent decades, not only for direct post-operative care following major cancer surgery, but also for cancer patients in need of organ function replacement due to the manifestation of their malignancy or toxicity of the therapies provided. This thesis studies the epidemiology and outcome of critical illness associated with cancer and/or its treatment in the Netherlands. Chapters 2-5 describe the proportion of cancer patients that requires admission to an Intensive Care Unit (ICU) during the course of their disease and their characteristics and outcome once in the ICU. Chapters 6 and 7 focus on infectious complications in cancer patients. Chapter 8 & 9 contains the summary, general discussion and future perspectives. Show less
Lam, S.W.; Groot, S.M. de; Honkoop, A.H.; Nota, N.M.; Jager, A.; Velden, A.M.T. van der; ... ; Dutch Breast Canc Trialists' Grp B 2013