Nosocomial septicemia in the cancer patient: The influence of central venous access devices, neutropenia, and type of malignancy

Nosocomial septicemias that occurred over a 32‐month period on an inpatient medical oncology service were reviewed. One hundred four episodes of septicemia occurred in 84 patients, 33% with solid tumors and 67% with leukemia or lymphoma. Sixty were primary septicemias, with the remainder being secondary. Of the 118 isolates recovered, 42% were Gram‐positive organisms, 45% Gram‐negative organisms, and 13% were fungi. Coagulase‐negative staphylococci and Escherichia coli were the most common Gram‐positive and Gram‐negative isolates, respectively. The effect of the type of malignancy, neutropenic status, and presence of a central venous access device (CVAD) on the isolate(s) recovered was studied. Coagulase‐negative staphylococci were more commonly isolated from leukemia‐lymphoma patients (26% vs. 3%, P<.01), while Gram‐negative isolates (63% vs. 36%, P = .01), specifically Klebsiella species (21% vs. 5%, P = .02), were more common in solid tumor patients. Staphylococcus aureus was isolated more frequently from non‐neutropenic patients than from those with neutropenia (19% vs. 4%, P = .02). Gram‐positive isolates were more commonly found in patients with a CVAD (51% vs. 29%, P = .03), in particular coagulase‐negative staphylococci (29% vs. 2%, P<.001). In contrast, Gram‐negative isolates (62% vs. 34%), especially Klebsiella species (22% vs. 3%, P <.01) and S. aureus (18% vs. 5%, P = .07) were more commonly isolated from patients with no CVAD. Neither neutropenia nor the presence of a CVAD predisposed to early mortality. Our data suggest that empiric antimicrobial coverage for presumed nosocomial septicemia in the febrile cancer patient should include vancomycin for patients with a CVAD to cover coagulase‐negative staphylococci and a cephalosporin for patients with solid tumors, especially those without a CVAD, to cover Klebsiella species.