Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study
Makaleler > Tam Makale · 2023
Yazarlar: Hakan Erdem, Esra Kocoglu, Handan Ankarali, Rehab El-Sokkary, Atousa Hakamifard, Ridvan Karaali, Sholpan Kulzhanova, Amani El-Kholy, Hamed Azhdari Tehrani, Reham Khedr, Ayse Kaya-Kalem, Nenad Pandak, Meliha Cagla-Sonmezer, Summiya Nizamuddin, Hande Berk-Cam, Rahmet Guner, Jehan Ali Elkholy, Ferran Llopis, Andrea Marino, Roman Stebel, Balint Gergely Szabo, Maya Belitova, Elias Fadel, Tarkan Yetisyigit, Yasemin Cag, Sevil Alkan, Bircan Kayaaslan, Serkan Oncu, Mehmet Ozdemir, Mesut Yilmaz, Arzu Cennet Isik, Dilsah Baskol, Gulden Sincan, Antonio Cascio, Safak Ozer-Balin, Nesibe Korkmaz, Rezaul Karim Ripon, Salma Abbas, Irina Magdalena Dumitru, Gulden Eser-Karlidag, Massimiliano Lanzafame, Abdur Rafey, Aun Raza, Oğuz Reşat SİPAHİ, Ilad Alavi Darazam, Umran Elbahr, Ilknur Erdem, Pinar Ergen, Cemil Bilir, Hulya Caskurlu, Aysegul Erdem, Mateja Jankovic Makek, Mustafa Altindis, Botond Lakatos, Catalina Mihaela Luca, Esmeray Mutlu Yilmaz, Emmanuel Nsutebu, Rumeysa Cakmak, Fatma Sirmatel
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, SCI İndekslerine Giren Dergi, Uluslararası, Wos, 2023, cilt 62, ss 106919-106919
DOI: 10.1016/j.ijantimicag.2023.106919
Özet
Objectives: Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management.Methods: The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). Results: A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120- 3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. Conclusions: Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.& COPY; 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.