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Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study
H. Erdem, E. Kocoglu, H. Ankarali, R. El-Sokkary, A. Hakamifard, R. Karaali, S. Kulzhanova, A. El-Kholy, HA. Tehrani, R. Khedr, A. Kaya-Kalem, N. Pandak, M. Cagla-Sonmezer, S. Nizamuddin, H. Berk-Cam, R. Guner, JA. Elkholy, F. Llopis, A. Marino,...
Language English Country Netherlands
Document type Journal Article, Observational Study
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Bacteremia * drug therapy MeSH
- Escherichia coli MeSH
- Febrile Neutropenia * drug therapy MeSH
- Hematologic Neoplasms * complications MeSH
- Humans MeSH
- Staphylococcal Infections * drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
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.
Clinical Infectious Diseases Hospital Constanta Ovidius University of Constanta Romania
Department of Anaesthesia Pain Management Cairo University Hospital Cairo Egypt
Department of Clinical Pathology Faculty of Medicine Cairo University Giza Egypt
Department of Haematology School of Medicine Ataturk University Erzurum Türkiye
Department of Infectious Diseases and Clinical Microbiology Ankara City Hospital Ankara Türkiye
Department of Infectious Diseases and Clinical Microbiology Ege School of Medicine Izmir Türkiye
Department of Infectious Diseases Astana Medical University Nur Sultan Kazakhstan
Department of Internal Medicine Dr Lutfi Kirdar City Hospital Istanbul Türkiye
Department of Medical Microbiology Necmettin Erbakan University Konya Türkiye
Department of Medicine Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan
Department of Microbiology Sakarya University Faculty of Medicine Sakarya Türkiye
Department of Oncology Bahrain Oncology Centre King Hamad University Hospital Busaiteen Bahrain
Department of Oncology Istinye University VMMedical Park Pendik Hospital Istanbul Türkiye
Department of Pathology Ataturk Sanatoryum Training and Research Hospital Ankara Türkiye
Department of Public Health and Informatics Jahangirnagar University Savar Dhaka Bangladesh
Emergency Department Bellvitge University Hospital l'Hospitalet de Llobregat Barcelona Spain
S Maria Della Misericordia Hospital Rovigo Italy
Sakarya University Faculty of Medicine Department of Medical Oncology Sakarya Türkiye
St Parascheva Clinical Hospital of Infectious Diseases Iasi Romania
The Royal Hospital Muscat Oman
University of Zagreb School of Medicine University Hospital Centre Zagreb Zagreb Croatia
References provided by Crossref.org
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- $a Erdem, Hakan $u Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain; Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Türkiye. Electronic address: erdemhakan@gmail.com
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- $a Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study / $c H. Erdem, E. Kocoglu, H. Ankarali, R. El-Sokkary, A. Hakamifard, R. Karaali, S. Kulzhanova, A. El-Kholy, HA. Tehrani, R. Khedr, A. Kaya-Kalem, N. Pandak, M. Cagla-Sonmezer, S. Nizamuddin, H. Berk-Cam, R. Guner, JA. Elkholy, F. Llopis, A. Marino, R. Stebel, BG. Szabo, M. Belitova, E. Fadel, T. Yetisyigit, Y. Cag, S. Alkan, B. Kayaaslan, S. Oncu, M. Ozdemir, M. Yilmaz, AC. Isik, D. Başkol, G. Sincan, A. Cascio, S. Ozer-Balin, N. Korkmaz, RK. Ripon, S. Abbas, IM. Dumitru, G. Eser-Karlidag, M. Lanzafame, A. Rafey, A. Raza, OR. Sipahi, IA. Darazam, U. Elbahr, I. Erdem, P. Ergen, C. Bilir, H. Caskurlu, A. Erdem, MJ. Makek, M. Altindis, B. Lakatos, CM. Luca, EM. Yilmaz, E. Nsutebu, R. Cakmak, F. Sirmatel
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- $a 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.
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