Incidence of hospital-onset bacteremia and fungemia in solid organ malignancy, hematologic malignancy, and hematopoietic cell transplant patients.

OBJECTIVE

To evaluate the incidence of hospital-onset bacteremia and fungemia (HOB) among solid organ malignancy (SOM), hematologic malignancy (HM), and hematopoietic cell transplant (HCT) therapy patients at a large cancer care center.

METHODS

A single-center, observational, retrospective analysis was conducted for hospitalizations between January 1, 2018, and September 30, 2024, to identify patients with a first positive blood culture on or after day four of hospitalization. Hospitalizations were grouped into three categories: SOM, HM with HCT, and HM without HCT. The primary objective was to study the incidence of HOB. Secondary objectives: identification of risk factors for HOB events and pathogens associated with HOB events.

RESULTS

In 45,896 admissions, 1,470 HOB events were identified (incidence: 3.2%). The incidence of HOB was highest in the HM/HCT cohort (3.8%), followed by HM without HCT (2.3%) and SOM (0.9%). Risk factors of HOB identified included HM (OR 1.49), hospitalization within the past 90 days (OR 1.50), length of stay greater than or equal to 30 days (OR 6.74), intensive care unit (ICU) admission (OR 4.06), development of a CAUTI during admission (OR 23.23), or presence of a central line (OR 51.61). The most common pathogens were Escherichia coli (20.1%), coagulase-negative Staphylococci (19.0%), and Viridians streptococci (11.3%).

CONCLUSION

This study highlights the high incidence of HOB among cancer and HCT patients. The risk factors and differential rates of HOB in subpopulations of this demographic may help to inform targeted infection prevention efforts in cancer centers.