Dissecting bloodstream infections in febrile neutropenic patients with hematological malignancies, a decade-long single center retrospective observational study (2009–2019)

El Omri, Halima; Padmanabhan, Regina; Taha, Ruba Y.; Kassem, Nancy; Elsabah, Hesham; Ellahie, Anil Yousaf; Santimano, Antonio J.J.; Al-Maslamani, Muna A.; Omrani, Ali S.; Elomri, Adel; El Omri, Abdelfatteh

doi:10.1016/j.jiph.2023.11.017

Cited by 2 publications

References 46 publications

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Arsenic treatment of acute promyelocytic leukemia affects neutrophil function in a compensatory manner

Salzer,

Urban

2024

transl med commun

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Background Arsenic (ATO) and retinoic acid (ATRA) are successfully used as chemotherapy-free regimens to treat acute APL. Compared to traditional chemotherapy approaches, this therapy evokes fewer haematological side effects, such as severe neutropenia and thrombocytopenia, but little is known about the impact of the treatment on neutrophil function. Methods We included three patients undergoing consolidation treatment for APL. To evaluate the functionality of neutrophils, we assessed chemotaxis, ROS production, and neutrophil extracellular trap (NET) release during different time points of the treatment and compared them with neutrophils from healthy donors. Results We revealed that the chemotactic ability of neutrophils isolated from APL patients was decreased before starting each cycle of treatment. However, there was an increase in chemotactic ability in the first week of treatment compared to other time points. Additionally, we observed increased ROS production at the start of the treatment cycle. In vitro exposure of isolated neutrophils from healthy donors to ATO led to decreased chemotaxis at high ATO concentrations exceeding those achieved in vivo, while ROS production was not affected. Chemotaxis and ROS production were not altered by exposure to ATRA in vitro and neither ATO nor ATRA had an effect on neutrophils’ ability to release NETs. Conclusions Our study suggests that ATO and ATRA therapy alter neutrophil function by increasing chemotaxis and reducing ROS production. The effect on neutrophil function does not, however, seem to impact infection susceptibility in our patients, indicating that the enhanced functionality might compensate for the lowered neutrophil count.

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Arsenic treatment of acute promyelocytic leukemia affects neutrophil function in a compensatory manner

Salzer,

Urban

2024

transl med commun

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Ceftazidime-Avibactam for the Treatment of Febrile Neutropenia in HSCT Recipients and Acute Leukemia Patients Post Induction Chemotherapy

Frem,

Khazzeka,

Allaw

et al. 2024

Preprint

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Background Febrile neutropenia is a common and major complication in patients with acute leukemia or those undergoing hematopoietic stem cell transplantation (HSCT). Understanding patient characteristics and patterns of susceptibility in febrile neutropenia is essential to provide the appropriate antimicrobial therapy. First-line agents should have Pseudomonas coverage, but with the increase in multi-drug resistant organisms, ceftazidime-avibactam has emerged as a new therapy in febrile neutropenia. Methods This is a retrospective case-control study of a total of 300 admissions (143 patients) between January 2009 and December 2017. Patients with hematologic neoplasms and patients that underwent HSCT who satisfied the definition of febrile neutropenia and treated with ceftazidime-avibactam (CAZAVI) were included in the study. A bivariate regression model to explore independent predictors of septic shock and mortality was constructed. Results Patients who received ceftazidime-avibactam (CAZAVI) were more likely to have a microbiologically documented infection (59.0% vs. 28.3%). Almost all complications were significantly more frequent in the CAZAVI group, with sepsis being the most common, occurring in 59.0% of patients in the CAZAVI arm. Our multivariable logistic regression analysis showed that receiving CAZAVI was an independent risk factor for both sepsis and mortality (aOR 6.33 [95% CI 2.81–14.30] and 7.82 [2.63–23.26], respectively). Conclusion Knowing the most common organisms isolated during a neutropenic fever episode as well as the patterns of resistance, compounded with an understanding of the risk factors for morbidity and mortality in such a vulnerable population, is key to providing them with appropriate prophylactic and therapeutic management. In addition, more studies should be done on the effectiveness of ceftazidime-avibactam in treating febrile neutropenia in the population at hand.

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Dissecting bloodstream infections in febrile neutropenic patients with hematological malignancies, a decade-long single center retrospective observational study (2009–2019)

Cited by 2 publications

References 46 publications

Arsenic treatment of acute promyelocytic leukemia affects neutrophil function in a compensatory manner

Arsenic treatment of acute promyelocytic leukemia affects neutrophil function in a compensatory manner

Ceftazidime-Avibactam for the Treatment of Febrile Neutropenia in HSCT Recipients and Acute Leukemia Patients Post Induction Chemotherapy

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