Urinary Tract Infections in Patients with Solid Tumors: Retrospective Study

Abstract

Purpose: Urinary tract infection (UTI) is one of the most common infections in patients with cancer. It may occur at different phases of the disease and results from the interaction of several factors. The objective of our study was to determinate the particularities of these infection in this special population. Patients and Methods: Retrospective study including all patients followed for solid tumor in the medical oncology who had developed at least one episode of UTI documented between 2017 and 2019. Results: Forty-six patients were collected: 24 women and 22 men. The median age was 57 years. A history of diabetes and urolithiasis were found in 23.9% and 19.6% of cases respectively. The site of the primary tumor waspelvic in 30 cases (65.3%), including 17 bladder tumors, and extra-pelvic in the other cases. Ten patients (21.7%) had recurrent episodes of UI during their follow-up, including 8 cases of bladder tumors. Urinary catheters was used in ten cases. All the patients had received at least one line of chemotherapy. The majority of UTIs (82.6%) occurred during cycles of chemotherapy, 26% of which were associated with febrile neutropenia. The most common bacteria was Escherichia coli (58.6%) which was resistant to cefotaxime and ciprofloxacin in 25% and 39.3% of cases respectively. Seven patients (15%) presented polymicrobial UTIs. The urine contained at least one multi-resistant germs in 26.1% of cases more frequently in pelvic tumors then extra-pelvic tumors (36.2% versus 6.2%; p = 0.035), in the presence of urinary catheter (70% versus 13.9% in the absence of catheter; p = 0.001) and during chemotherapy (35.7% versus 6.2% apart from chemotherapy; p = 0.02), the UTI was complicated of bacteremia in 6 cases (13%), four of which were undergoing chemotherapy and three were associated with febrile neutropenia, resulting in one case in septic shock and death. Conclusion: It seems necessary, following this study, to implement recommendations for treatment and prevention of UTIs in solid tumors. They must be particularly adapted to the level of risk incurred by the different risk factors.