Publication details

Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study

Authors	ERDEM Hakan KOCOGLU Esra ANKARALI Handan EL-SOKKARY Rehab HAKAMIFARD Atousa KARAALI Ridvan KULZHANOVA Sholpan EL-KHOLY Amani TEHRANI Hamed Azhdari KHEDR Reham KAYA-KALEM Ayse PANDAK Nenad CAGLA-SONMEZER Meliha NIZAMUDDIN Summiya BERK-CAM Hande GUNER Rahmet ELKHOLY Jehan Ali LLOPIS Ferran MARINO Andrea STEBEL Roman SZABO Balint Gergely BELITOVA Maya FADEL Elias YETISYIGIT Tarkan CAG Yasemin ALKAN Sevil KAYAASLAN Bircan ONCU Serkan OZDEMIR Mehmet YILMAZ Mesut ISIK Arzu Cennet BASKOL Dilsah SINCAN Gulden CASCIO Antonio OZER-BALIN Safak KORKMAZ Nesibe RIPON Rezaul Karim ABBAS Salma DUMITRU Irina Magdalena ESER-KARLIDAG Gulden LANZAFAME Massimiliano RAFEY Abdur RAZA Aun SIPAHI Oguz Resat DARAZAM Ilad Alavi ELBAHR Umran ERDEM Ilknur ERGEN Pinar BILIR Cemil CASKURLU Hulya ERDEM Aysegul MAKEK Mateja Jankovic ALTINDIS Mustafa LAKATOS Botond LUCA Catalina Mihaela YILMAZ Esmeray Mutlu NSUTEBU Emmanuel CAKMAK Rumeysa SIRMATEL Fatma
Year of publication	2023
Type	Article in Periodical
Magazine / Source	International Journal of Antimicrobial Agents
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.sciencedirect.com/science/article/pii/S092485792300198X
Doi	http://dx.doi.org/10.1016/j.ijantimicag.2023.106919
Keywords	Febrile neutropenia; Bacteraemia; Antimicrobial; Resistance; Antibiotic stewardship
Description	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.