Clinical and microbiological characteristics of abscesses in patients with malignancy and factors associated with 90-day mortality
- 1Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Türkiye
- 2Department of Internal Medicine, Ankara Bilkent City Hospital, Ankara, Türkiye
Abstract
Introduction: Cancer-specific evidence on the outcomes and microbiology of abscesses is limited. We aimed to characterize these infections and evaluate factors associated with 90-day all-cause mortality.
Methods: We conducted a single-center retrospective cohort study of adults with histologically confirmed malignancy and a first imaging-confirmed abscess; culture positivity was not required. All isolates came from percutaneous aspirates, were tested by an automated system, and were classified for extended-spectrum beta-lactamase (ESBL) production and multidrug resistance; culture reports were adjudicated for contamination by two clinicians. Survival was measured from the index date (aspiration in 177 and first documentation in seven), with first imaging and admission as alternative origins, and follow-up extended to 1 year.
Results: Among 184 patients (median age, 62 years; 58.2% men; 53.8% stage IV), an organism was recorded in 124 (67.4%) and a probable pathogen in 108 (58.7%), of which 85 (78.7%) were gram-negative, mainly Escherichia coli (43) and Klebsiella pneumoniae (27). Phenotypic ESBL was recorded in 38 of 80 (47.5%) Enterobacterales isolates, 69 of 85 (81.2%) gram-negative isolates were multidrug- or extensively drug-resistant, and resistance to third-generation cephalosporins exceeded 80%, to piperacillin–tazobactam 65.7%, and to ertapenem 37.3%. A total of 42 patients died within 90 days; the 90-day survival was 76.6% (95% CI 69.7%–82.2%) from the index date and 77.7% from first imaging, both among patients who survived to the index date. In a Cox model stratified by abscess multiplicity and adjusted for age and stage, higher albumin at the index date was associated with a lower 90-day mortality (HR 0.37 per 0.5 g/dL, 95% CI 0.26–0.53; model-based risk 39.4% at 2.5 g/dL versus 6.8% at 3.5 g/dL). The association persisted after adjustment for intensive-care admission, organ support, corticosteroids, C-reactive protein, and procalcitonin but weakened after day 90 (HR 0.48 per 1 g/dL), whereas stage IV disease, unrelated to 90-day mortality, was associated with mortality thereafter (HR 2.65, 95% CI 1.45–4.84).
Discussion: Ninety-day mortality was substantial, gram-negative organisms predominated, and resistance to these agents was frequent. Low albumin at the index date is a marker of early mortality that most likely reflects acute illness severity as well as nutritional and tumor-related factors, whereas cancer stage is associated with later mortality.
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BibTeX
@article{gencer2026clinical,
title = {{Clinical and microbiological characteristics of abscesses in patients with malignancy and factors associated with 90-day mortality}},
author = {Huseyin Gencer and Fahriye Tugba Kos and Mustafa Guven and Muharrem Calıskan and Ugur Ozberk and Oznur Bal and Muhammed Bulent Akinci},
journal = {Frontiers in Cellular and Infection Microbiology},
year = {2026},
month = oct,
doi = {10.3389/fcimb.2026.1969735},
url = {https://doi.org/10.3389/fcimb.2026.1969735},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical and microbiological characteristics of abscesses in patients with malignancy and factors associated with 90-day mortality
AU - Huseyin Gencer
AU - Fahriye Tugba Kos
AU - Mustafa Guven
AU - Muharrem Calıskan
AU - Ugur Ozberk
AU - Oznur Bal
AU - Muhammed Bulent Akinci
PY - 2026
DA - 2026/10/21
JO - Frontiers in Cellular and Infection Microbiology
DO - 10.3389/fcimb.2026.1969735
UR - https://doi.org/10.3389/fcimb.2026.1969735
AB - Introduction: Cancer-specific evidence on the outcomes and microbiology of abscesses is limited. We aimed to characterize these infections and evaluate factors associated with 90-day all-cause mortality. Methods: We conducted a single-center retrospective cohort study of adults with histologically confirmed malignancy and a first imaging-confirmed abscess; culture positivity was not required. All isolates came from percutaneous aspirates, were tested by an automated system, and were classified for extended-spectrum beta-lactamase (ESBL) production and multidrug resistance; culture reports were adjudicated for contamination by two clinicians. Survival was measured from the index date (aspiration in 177 and first documentation in seven), with first imaging and admission as alternative origins, and follow-up extended to 1 year. Results: Among 184 patients (median age, 62 years; 58.2% men; 53.8% stage IV), an organism was recorded in 124 (67.4%) and a probable pathogen in 108 (58.7%), of which 85 (78.7%) were gram-negative, mainly Escherichia coli (43) and Klebsiella pneumoniae (27). Phenotypic ESBL was recorded in 38 of 80 (47.5%) Enterobacterales isolates, 69 of 85 (81.2%) gram-negative isolates were multidrug- or extensively drug-resistant, and resistance to third-generation cephalosporins exceeded 80%, to piperacillin–tazobactam 65.7%, and to ertapenem 37.3%. A total of 42 patients died within 90 days; the 90-day survival was 76.6% (95% CI 69.7%–82.2%) from the index date and 77.7% from first imaging, both among patients who survived to the index date. In a Cox model stratified by abscess multiplicity and adjusted for age and stage, higher albumin at the index date was associated with a lower 90-day mortality (HR 0.37 per 0.5 g/dL, 95% CI 0.26–0.53; model-based risk 39.4% at 2.5 g/dL versus 6.8% at 3.5 g/dL). The association persisted after adjustment for intensive-care admission, organ support, corticosteroids, C-reactive protein, and procalcitonin but weakened after day 90 (HR 0.48 per 1 g/dL), whereas stage IV disease, unrelated to 90-day mortality, was associated with mortality thereafter (HR 2.65, 95% CI 1.45–4.84). Discussion: Ninety-day mortality was substantial, gram-negative organisms predominated, and resistance to these agents was frequent. Low albumin at the index date is a marker of early mortality that most likely reflects acute illness severity as well as nutritional and tumor-related factors, whereas cancer stage is associated with later mortality.
SN - 2235-2988
ER -