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Prospective Analysis of Febrile Neutropenia Patients With Bacteraemia: The Results of an International Id–Iri Study Publisher Pubmed



Erdem H1, 2 ; Kocoglu E3 ; Ankarali H4 ; Elsokkary R5 ; Hakamifard A6, 7 ; Karaali R8 ; Kulzhanova S9 ; Elkholy A10 ; Tehrani HA11 ; Khedr R12 ; Kayakalem A13 ; Pandak N14 ; Caglasonmezer M15 ; Nizamuddin S16 Show All Authors
Authors
  1. Erdem H1, 2
  2. Kocoglu E3
  3. Ankarali H4
  4. Elsokkary R5
  5. Hakamifard A6, 7
  6. Karaali R8
  7. Kulzhanova S9
  8. Elkholy A10
  9. Tehrani HA11
  10. Khedr R12
  11. Kayakalem A13
  12. Pandak N14
  13. Caglasonmezer M15
  14. Nizamuddin S16
  15. Berkcam H17
  16. Guner R13
  17. Elkholy JA18
  18. Llopis F19
  19. Marino A20
  20. Stebel R21
  21. Szabo BG22
  22. Belitova M23
  23. Fadel E24
  24. Yetisyigit T24
  25. Cag Y25
  26. Alkan S26
  27. Kayaaslan B13
  28. Oncu S27
  29. Ozdemir M28
  30. Yilmaz M29
  31. Isik AC30
  32. Baskol D31
  33. Sincan G32
  34. Cascio A33
  35. Ozerbalin S34
  36. Korkmaz N35
  37. Ripon RK36
  38. Abbas S37
  39. Dumitru IM38
  40. Eserkarlidag G39
  41. Lanzafame M40
  42. Rafey A37
  43. Raza A37
  44. Sipahi OR31
  45. Darazam IA41
  46. Elbahr U1
  47. Erdem I42
  48. Ergen P25
  49. Bilir C43, 44
  50. Caskurlu H25
  51. Erdem A45
  52. Makek MJ46
  53. Altindis M47
  54. Lakatos B22
  55. Luca CM48
  56. Yilmaz EM49
  57. Nsutebu E50
  58. Cakmak R29
  59. Sirmatel F51

Source: International Journal of Antimicrobial Agents Published:2023


Abstract

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. © 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy
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