Lancet Respir Med. All data associated with this study is available at www.seer.cancer.gov. Sagar AES, Evans SE. 2013;346:f1235. Gonzalez C, et al. No previous studies have investigated infectious diseases as a cause of death in cancer patients among a large population or reported the trends in infectious diseases as a cause of death and the possible risk factors. Aerodigestive tract, lung and haematological cancers are risk factors for tuberculosis: an 8-year population-based study. van der Eerden MM, Boersma WG. The immune system in cancer pathogenesis: potential therapeutic approaches. Pneumonia is usually caused by bacterial or viral infection at the pulmonary parenchyma which constitutes a crucial risk for morbidity and mortality worldwide 1,2.Community-Acquired Pneumonia (CAP . 1943 Apr 24; 1 (4294):497-500. Epidemiology of HIV infection in the United States: implications for linkage to care. Cancer. 2006;106(10):225866. African American cancer patients were more likely to die from infection than other races. Simard EP, Engels EA. community-onset pneumonia with febrile neutropenia. Clin Microbiol Infect. Jansen KU, Knirsch C, Anderson AS. Warren AG, et al. Biggar RJ, et al. A lack of synergistic effect between macrolide and -lactam against S. pneumoniae has been described [24,25,26]. The third and fourth groups included cancer patients infected with parasitic, HIV, and other infectious diseases and were divided into subgroups based on marital status: married, separated, or widowed (median survival=840days) and single, unmarried, or domestic partner (median survival=360days) (Fig. The concept that combination treatment may be unnecessary can be applied to neutropenic pneumonia. 1992;32:223. Pneumonitis is a rare immune-related adverse event that presents in distinct patterns. Ann Oncol. Data used in the analysis were acquired from the Surveillance, Epidemiology, and End Results (SEER) 17 Registry, which includes data on tumors diagnosed between 1973 and 2014 [30]. Clin Infect Dis. Cell Host Microbe. The average survival time was 65.31months; moreover, pneumonia and influenza had the highest survival rate (Table 1). CAS http://www.seer.cancer.gov. There are several limitations to our study. Pneumonia, Pneumocystis / mortality Pneumonia, Pneumocystis / pathology Pneumonia, Pneumocystis . To verify the effect of combination therapy on all-cause mortality due to neutropenic pneumonia, we also performed a subgroup analysis controlling for -lactam antibiotics, specifically cefepime which made up the highest proportion among the various -lactams (63.0%). Your US state privacy rights, Survival decision tree identifying the four groups with their respective predicted survival. Adult (age18years) cancer patients who were diagnosed with community-onset neutropenic pneumonia during the study period were included in the analysis. Epidemiology of human immunodeficiency virus in the United States. Eur J Cancer. Accessed 29 Nov 2019. de Montmollin E, et al. Clin Microbiol Rev. 2003;14(3):44954. These problems can be overcome without the use of unnecessary antibiotics. We performed the proportional hazards assumption of Cox regression to ensure that the assumption is satisfied. Our sample included 151,440 patients who died of infectious diseases (mean age, 66.33years; 62% male). & Msherghi, A. Data collection: HS, JYK, JHL, GEP. The complexity of aging: cancer risk among elderly people and infectious risk among those with cancer. Clin Infect Dis. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Addition of a macrolide to a ss-lactam in bacteremic pneumococcal pneumonia. Br Med J. Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, et al. PubMed This study showed that neither monotherapy nor combination therapy was associated with 30- and 90-day mortality in the treatment of neutropenic pneumonia. Ann Hematol. 1976;55(3):25968. J Infect. The significant variables obtained from the Cox regression analysis were used to construct a nomogram. In reality, pneumonia is the primary cause of death in patients with acute leukemia during the transfusion period [20, 21]. Therefore, no formal ethics approval was required in this study. To identify potential confounding factors of 30-day all-cause mortality, all relevant variables were evaluated in a univariate fashion using the Cox proportional hazard model (Table4). As cytotoxic chemotherapy-induced FN may lead to serious complications of infection and mortality, initiating antimicrobial therapy is recommended for this patient population. 2016;72(6):6508. This is also the limitation of retrospective study, and efforts to find causative organisms of pneumonia through the tests including urinary antigen detection, respiratory virus PCR panels, sputum cultures are needed. 2006;25(8):51821. The multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. To compare the two groups, the Pearson 2 test and Fishers exact test were used for categorical variables, and Students t-test and the Mann-Whitney U test for continuous variables. Article In this instance, patients were considered in the study dataset if their cause of death was infectious diseases, which included the following groups: pneumonia and influenza, septicemia, syphilis, tuberculosis, and other infectious and parasitic diseases, including HIV. A significant difference was observed in survival between men and women (P<0.0001), different organisms, race, and marital status (P<0.0001). Cancer Epidemiol Biomark Prev. Shock. In the combination group, azithromycin was most frequently used for coverage of atypical pathogens, followed by levofloxacin, ciprofloxacin, and moxifloxacin (75.3, 11.8, 8.6, and 4.3%, respectively). Pneumonia is a common cause of death in all patient groups. Kobashi Y, et al. Diagnosis. Virulence. PubMedGoogle Scholar. 2014;6(10):404779. Part of Anderson T. Aspects of the Chemotherapy of Pneumonia. Infections in neutropenic patients can progress rapidly, leading to hypotension and/or other life-threatening complications. The response to chemotherapy was evaluated according to the World Health Organization criteria or Response Evaluation Criteria in Solid Tumors guidelines [19,20,21]. volume16, Articlenumber:72 (2021) https://doi.org/10.1186/s41479-019-0061-1, DOI: https://doi.org/10.1186/s41479-019-0061-1. Febrile neutropenia remains an important complication of treatment with cytotoxic chemotherapy. CAS Additional use of other classes of antibiotics that do not have activity for atypical bacterial pathogens, such as aminoglycosides or vancomycin, was not considered when classifying study groups. Freifeld AG, et al. This was clearly observed in line with HIV infection epidemiology in the USA [48, 49]. Results: Between January 2001 and December 2005, 1225 (222 small cell and 1003 . Writing review & editing: HS, JHK, KRP, JYK, JHL, GEP, SYC, CIK, NYL, DRC. zdemir BC, Dotto G-P. 2007;20(3):47888. Shapiro MF, et al. Combination antibiotic regimens were not associated with a survival benefit over -lactam monotherapy in the treatment of community-onset neutropenic pneumonia. In conclusion, this study revealed no differences in 30- and 90-day mortality between -lactam monotherapy and combination therapy in cancer patients with non-severe community-onset neutropenic pneumonia. Elhadi, M., Khaled, A. Empyema. However, several studies have shown that -lactam monotherapy is non-inferior to combination therapy [8,9,10]. Monotherapy can reduce the chance of unwanted drug adverse reactions and acquisition of antibiotic resistance. As these changes in preferred regimens depending on the period may have introduced some bias, we performed a subgroup analysis of cefepime-treated patients, and also found no difference in outcomes between the two groups, supporting the results of the main cohort. 2000;18(16):303851. 2003;47(3):11513. Among various clinical presentations of febrile neutropenia, pneumonia is considered high-risk [2]. Google Scholar. 2017;72(7):5967. Breast Care (Basel, Switzerland). All collected variables with any relevance to outcomes were evaluated by univariate analysis, and those with statistical significance were included in the multivariate analysis. 2009;45(2):22847. 4) included patients with pneumonia and influenza, septicemia, syphilis, and tuberculosis aged<75.5years, with a median survival of 2370days. Cancer patients also have a higher risk for tuberculosis (TB). Pneumonia can cause nearly 10% of hospital admissions among cancer patients, especially those with hematologic malignancies, who have a pneumonia risk exceeding 30% during treatment [17,18,19]. Nosocomial aspergillosis has been recognized increasingly as a cause of severe illness and mortality in highly immunocompromised patients (e.g., patients undergoing chemotherapy and/or organ transplantation, including bone-marrow transplantation for hematologic and other malignant neoplasms) (468-472). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 2010;21(Suppl 5):v2526. Arnold FW, et al. Privacy A trend analysis of annual cancer deaths caused by infectious diseases was conducted. Febrile neutropenia, an inevitable side effect of chemotherapy, contributes to high mortality among cancer patients [1]. 2007;369(9560):48290. Google Scholar. Methods: We retrospectively analyzed the incidence and risk factors of TRD in lung cancer patients who received chemotherapy and/or thoracic radiotherapy using logistic regression analyses. Appropriate risk stratification for primary and secondary VTE prevention as well as for risk of early death in acute setting is needed for an adequate treatment. Cham: Springer; 2020. p. 60723. The most common cancer associated with infectious diseases was prostate cancer, followed by breast cancer, and Kaposi sarcoma. Background Various host factors can promote pneumonia susceptibility of lung cancer patients. Although we performed a multivariate analysis to adjust for potential confounding factors, the types of -lactams were significantly unbalanced between the two groups. Thus, the purpose of this study was to identify risk factors for pneumonia development in lung cancer patients. The rate of febrile neutropenic-related mortality is up to 11%; in the case of severe sepsis, it can reach 50% [25]. Brand JS, et al. For septicemia, patients with hematologic tumors other than leukemia, lymphoma, plasma cell tumors, and mast cell tumors had the highest incidence of septicemia, estimated to be 51.89% per 100 patients (SIR=51.9, 95% CI=1.31289.16), followed by nerve sheath tumors (SIR=3.91, 95% CI=0.121.7), and mesothelial neoplasms (SIR=3.21, 95% CI=0.3911.60). Neoplastic complications of HIV infection. Article Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea, Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, Hyeri Seok,Jae-Hoon Ko,Kyong Ran Peck,Ji-Yeon Kim,Ji Hye Lee,Ga Eun Park,Sun Young Cho,Cheol-In Kang&Doo Ryeon Chung, Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, You can also search for this author in Kochanek M, et al. Article Fang P, Jagsi R, He W, et al. The second comprised patients aged>75.5years with a median survival of 1290 (red in Fig. 1981;47(1):20714. Effect of Chemotherapy on Pneumonia Mortality. Lin E, Stanek RJ, Mufson MA. The sample size calculation for the study resulted in a sample size of 134 patients who were to be in a 1:1 allocation ratio to achieve a power of 95%. Privacy Lancet. Categorical variables are expressed as percentages, while normally distributed continuous variables are expressed as mean and standard deviation; otherwise, variables are expressed as median and interquartile range. To prevent the escalation of sepsis syndrome and likely death, it is essential to promptly detect neutropenic fever and start empiric systemic antimicrobial therapy [37]. J Immunol Res. Infectious diseases as a cause of death among cancer patients: a trend analysis and population-based study of outcome in the United States based on the Surveillance, Epidemiology, and End Results database. The risk of TB in this patient group is due to immunosuppression caused by chemotherapy and local anatomical alterations in the lungs caused by primary lung cancer or metastasis [26]. Chemotherapy and radiation therapy have been shown to improve survival for patients with small cell lung cancer (SCLC). Millward MJ, et al. Bray F, et al. Therefore, early recognition of risk factors and timely intervention may help mitigate the negative consequences on patients quality of life and prognosis, which can improve the prognosis and prevent early death from infection, which is preventable in most cases, as shown by the trends that provide insight into the reduction of the infection-related cause of death with the emergence of new antimicrobial and immune-stimulating medications. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. Infectious Agents and Cancer Pneumonias are estimated to cause or complicate nearly 10% of hospital admissions among cancer patients, notably including patients with hematologic malignancies whose estimated risk of pneumonia during the course of treatment exceeds 30% [ 3, 5 - 8 ]. Provided by the Springer Nature SharedIt content-sharing initiative. Patients with non-Hodgkin's lymphoma (NHL) receiving rituximab-containing chemotherapy are at risk of developing respiratory complications, but comprehensive information on these complications and their impact on survival is lacking. Seventy-two patients received -lactam monotherapy and 93 received combination therapy (-lactam plus either a macrolide or fluoroquinolone). Avoidable cancer deaths globally. Most clinicians choose a combination of an antipseudomonal -lactam with azithromycin or fluoroquinolone targeting neutropenic fever and community-acquired pneumonia (CAP). Febrile neutropenia, an inevitable side effect of chemotherapy, contributes to high mortality among cancer patients [].Among various clinical presentations of febrile neutropenia, pneumonia is considered high-risk [].Guidelines do not specify empirical antibiotics for the treatment of neutropenic pneumonia, i.e.
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