scholarly journals The frequency, epidemiology and risk factors of bloodstream infections in febrile neutropenic patients with hematologic malignancies

2021 ◽  
Author(s):  
Çiğdem EROL ◽  
Nuran SARI ◽  
Şahika Zeynep AKI ◽  
Esin ŞENOL
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Neutropenic Patients

Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

2021 ◽  
Author(s):  
Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Kidney Injury ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Prospective Cohorts ◽  
Independent Risk Factors ◽  
The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

scholarly journals Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies

Leukemia ◽  
2005 ◽  
Vol 19 (4) ◽  
pp. 545-550 ◽  
Author(s):  
K Mühlemann ◽  
C Wenger ◽  
R Zenhäusern ◽  
M G Täuber
Keyword(s):  
Risk Factors ◽  
Invasive Aspergillosis ◽  
Hematologic Malignancies ◽  
Neutropenic Patients

A Retrospective Analysis of Risk Factors for Severe Clostridium Difficile Infection In Acute Leukemia and Aggressive Lymphoma.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3797-3797
Author(s):  
Laura Kyle Brett ◽  
Gerald R. Donowitz ◽  
Heather Cox ◽  
Gina Petroni ◽  
John Densmore
Keyword(s):  
Risk Factors ◽  
Hematologic Malignancies ◽  
Aggressive Lymphoma ◽  
Attributable Mortality ◽  
High Dose ◽  
Composite Outcome ◽  
Oral Vancomycin ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Neutropenic Patients

Abstract Abstract 3797 Introduction and Goals. Clostridium difficile infection (CDI) is increasing in frequency and severity. Risk factors for severity of illness and treatment recommendations for patients with concurrent aggressive hematologic malignancies have not been investigated, despite data showing that this population experiences a high rate of CDI. The goal of this study was to assess mortality associated from CDI as well as risk factors for severe CDI in a population of patients with acute hematologic malignancies. Methods. Ninety-three cases of CDI among 78 patients with active acute leukemia or aggressive lymphoma at the University of Virginia (UVa) Health System from 2004–2009 were studied retrospectively. Rates of all-cause mortality, attributable mortality secondary to CDI (defined as CDI with at least one of the following: active diarrhea, toxic megacolon, or pseudomembranes on colonoscopy at time of death), and a composite outcome (defined as at least one of the following: attributable mortality, ICU stay from CDI, pseudomembranous colitis, toxic megacolon, or colectomy) were assessed as adverse outcomes. The following potential risk factors for severe CDI were investigated, adjusting for age: onset and duration of neutropenia, exposure to high dose cytarabine, number of antimicrobials given, exposure to fluoroquinolone prophylaxis for neutropenic fever, and a designation of severe CDI as previously described (at least two of the following: white blood count >15,000 cells/mL, age >60 years, albumin <2.5 g/dL, temperature >38.3° C, or one of the following: ICU stay or pseudomembranous colitis). Results. All-cause mortality was 21.7%. CDI-attributable mortality was 14.1%. The rate of the composite outcome was 20.3%. All-cause mortality was higher in patients with leukemia and lymphoma than for all other patients hospitalized at this institution with CDI in 2008 (12.5% all-cause mortality, 76/610, p=0.015, 95% CI [13.2, 32.6]). Duration of neutropenic episode >14 days and neutropenia at diagnosis of CDI were associated with increased risk of attributable mortality (OR 3.12, 95% CI [0.82, 11.92], p=0.09; OR 3.39, 95% CI [0.57, 20.05], p=0.11). Cumulative duration of neutropenia >21 days was not associated with increased risk in adverse outcomes. Designation of severe CDI predicted an increase in all-cause mortality (OR 6.7, 95% CI [2.1, 21.5], p <0.001), attributable mortality (OR 11.5, 95% CI [2.3, 57.5], p <0.001), and the composite outcome, (OR 19.3, 95% CI [5.5, 74.7], p <0.001). Fluoroquinolone prophylaxis for neutropenic fever, high dose cytarabine, induction chemotherapy, or receipt of more than 2 concurrent antimicrobials were not associated with increased risk of all-cause mortality, attributable mortality or the composite outcome. Discussion. Patients with acute hematologic malignancies and concurrent CDI were at increased risk of all-cause and CDI-attributable mortality compared with similar data from UVa of all hospitalized patients. Prolonged neutropenia at time of CDI diagnosis was associated with an increased risk of CDI-attributable mortality, although this result was not statistically significant. Established criteria for diagnosing severe CDI were helpful at predicting poor outcomes in this population. Seven of the 10 neutropenic patients who died in this study did not receive oral vancomycin. Neutropenic patients with CDI may benefit from initial treatment with oral vancomycin instead of metronidazole, especially if other criteria for severe illness are present. Future research may assess effectiveness of oral vancomycin as initial treatment for CDI in neutropenic patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Changing epidemiology of catheter-related bloodstream infections in neutropenic oncohematological patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0251010
Author(s):  
Dajana Lendak ◽  
Pedro Puerta-Alcalde ◽  
Estela Moreno-García ◽  
Mariana Chumbita ◽  
Nicole García-Pouton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Treatment ◽  
Bloodstream Infections ◽  
Absolute Number ◽  
Multidrug Resistant ◽  
Significant Shift ◽  
Neutropenic Patients ◽  
Prior Antibiotic Treatment ◽  
Over Time

Background We aimed to describe the epidemiology of catheter-related bloodstream infections (CRBSIs) in onco-hematological neutropenic patients during a 25-year study period, to evaluate the risk factors for Gram-negative bacilli (GNB) CRBSI, as well as rates of inappropriate empirical antibiotic treatments (IEAT) and mortality. Materials/Methods All consecutive episodes of CRBSIs were prospectively collected (1994–2018). Changing epidemiology was evaluated comparing five-year time spans. A multivariate regression model was built to evaluate risk factors for GNB CRBSIs. Results 482 monomicrobial CRBSIs were documented. The proportion of CRBSIs among all BSIs decreased over time from 41.2% to 15.8% (p<0.001). CRBSIs epidemiology has been changing: the rate of GNB increased over time (from 11.9% to 29.4%; p<0.001), as well as the absolute number and rate of multidrug-resistant (MDR) GNB (from 9.5% to 40.0%; p = 0.039). P. aeruginosa increased and comprised up to 40% of all GNB. Independent factors related with GNB-CRBSIs were: longer duration of in-situ catheter (OR 1.007; 95%CI 1.004–1.011), older age (OR 1.016; 95%CI 1.001–1.033), prior antibiotic treatment with penicillins (OR 2.716; 95%CI 1.306–5.403), and current antibiotic treatment with glycopeptides (OR 1.931; 95%CI 1.001–3.306). IEATs were administered to 30.7% of patients, with the highest percentage among MDR P. aeruginosa (76.9%) and S. maltophillia (92.9%). Mortality rate was greater among GNB than GPC-CRBSI (14.4% vs 5.4%; p = 0.002), with mortality increasing over time (from 4.5% to 11.2%; p = 0.003). Conclusion A significant shift towards GNB-CRBSIs was observed. Secondarily, and coinciding with an increasing number of GNB-MDR infections, mortality increased over time.

scholarly journals Epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies

2019 ◽  
Vol 13 (08) ◽  
pp. 727-735
Author(s):  
Duygu Mert ◽  
Sabahat Ceken ◽  
Gulsen Iskender ◽  
Dicle Iskender ◽  
Alparslan Merdin ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Mortality Rate ◽  
Hematological Malignancies ◽  
Methicillin Resistance ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria

Introduction: Patients with hematological malignancies, who are in the high risk group for infectious complications and bacterial bloodstream infections. The aim of the study evaluated epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies. In addition to determine the risk factors, changes in the distribution and frequency of isolated bacterias. Methodology: In this retrospective study. There were investigated data from 266 patients with hematological malignancies and bacterial bloodstream infections who were hospitalized between the dates 01/01/2012 and 12/31/2017. Results: There were 305 blood and catheter cultures in febrile neutropenia attacks in total. In these total attacks, primary bloodstream infections were 166 and catheter-related bloodstream infections were 139. In blood cultures; Escherichia coli and Klebsiella pneumoniae bacteria were detected in 58,0% and 22,9% of the samples, respectively. 52,4% of the cultured Gram-negative bacterias were extended spectrum beta-lactamase (ESBL). Carbapenemase positive culture rate was 17,2% in Gram-negative bacteria cultures. Staphylococcus epidermidis was found in 38,4% of the Gram-positive bacteria cultures. In Gram-positive bacteria; methicillin resistance were detected in 82,2% of the samples. There was a statistically significant relationship between bloodstream infection and disease status. 60 patients with primary bloodstream infections were newly diagnosed. Conclusions: In patients with hematological malignancies, certain factors in the bloodstream infections increase the mortality rate. With the correction of these factors, the mortality rate in these patients can be reduced. The classification of such risk factors may be an important strategy to improve clinical decision making in high-risk patients, such as patients with hematological malignancies.

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