Prognostic Factors Influencing Mortality in Cancer Patients with Neutropenia and Bacteremia

González‐Barca, Eva; Fernández-Sevilla, Alberto; Carratalà, Jordi; Salar, Antonio; Peris, José-Esteban; Grañena, A; Gudiol, Francesc

doi:10.1007/s100960050345

Cited by 77 publications

(44 citation statements)

References 19 publications

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“…In a large study, 14% of 2,340 patients with underlying malignancy and an episode of nosocomial bloodstream infection had a polymicrobial infection (22). In cancer patients, neutropenia is considered as an important factor for polymicrobial bacteremia (23,24). However, 24% of cancer patients with polymicrobial bacteremia were not neutropenic (22).…”

Section: Discussionmentioning

confidence: 99%

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

Lay

Zhuang

et al. 2010

Intern. Med.

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Background Part of Aeromonas bacteremia is polymicrobial infection. However, a clinical comparison of monomicrobial and polymicrobial Aeromonas bacteremia has not hitherto been reported. Methods A retrospective analysis of medical records of patients with Aeromonas bacteremia at three large referral hospitals in Taiwan for an 8-year period (2001-2008) was conducted. Results There were 154 patients with monomicrobial Aeromonas bacteremia and 62 patients with polymicrobial Aeromonas bacteremia. In the polymicrobial infections, E. coli was the most common combined pathogen (42%), followed by Klebsiella spp. (24%) and Enterobacter spp. (16%). Multivariate logistic regression analysis revealed solid cancer as the risk factor for polymicrobial Aeromonas bacteremia, with male gender and cirrhosis as risk factors for monomicrobial Aeromonas bacteremia. However, of all types of solid cancer, hepatoma was associated with monomicrobial Aeromonas bacteremia. APACHE II score was the most important prognostic factor in both groups. Conclusion Aeromonas bacteremia in patients with cirrhosis or male gender tended to be monomicrobial. Polymicrobial Aeromonas bacteremia was associated with solid cancers. In either polymicrobial or monomicrobial Aeromonas bacteremia, prognosis could be predicted according to disease severity measured by APACHE II score.

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Section: Discussionmentioning

confidence: 99%

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

Lay

Zhuang

et al. 2010

Intern. Med.

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“…6,9,[18][19][20][21][22]26,31,35,[37][38][39][40][41][42][43]51,53,54 In addition, and, independently of the risk of bacterial resistance, the patient's clinical presentation may also predict a severe clinical course or further deterioration. 24,[55][56][57] The physician's clinical judgment is pivotal in this evaluation, and in any modification to be made in the antimicrobial regimen. …”

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confidence: 99%

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

et al. 2013

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Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'deescalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance. ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3 increasing resistance. The draft of these guidelines was discussed by the Expert Group at the ECIL-4 meeting in September 2011 and considers: i) bacterial epidemiology in neutropenic patients; ii) risk factors for resistance; iii) escalation and deescalation approaches; iv) the appropriate duration of empirical therapy; iv) non-conventional therapies against multi-resistant pathogens; and v) other issues on the management of bacterial infections in these patients. Up-dated slide sets from ECIL-4 covering these aspects are available on the websites of the four organizations involved in ECIL: the European Group for Blood and Marrow Transplantation, the European Organisation for Research and Treatment of Cancer, the Immunocompromised Host Society (ECIL), and the European Leukaemia Net. 12,13 This article summarizes the main ECIL recommendations on the initial empirical therapy of bacterial infections, but will also be valuable for the management of the many nonneutropenic but severely-immunosuppressed hematology patients. MethodsThe methodology of the ECIL conferences has been described previously. 11A working group of experts in the field of infectious diseases, microbiology or hematology was constituted, and reviewed the published literature in order to prepare proposals covering the following aspects: 1) empirical antibiotic therapy for...

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“…In patients with NHL, a high lactate dehydrogenase (LDH) level and the presence of bone marrow involvement were also significant. Studies that assessed risk factors for the consequences of neutropenia, including serious medical complications and mortality, were in patients with solid tumors, leukemias, and lymphomas in adults [30][31][32][33][34][35][36][37][38] and in children [39][40][41][42][43]. Significant predictors for neutropenic complications-including death (Table 4), bacteremia (Table 5), and length of hospital stay ≥10 days (Table 6)-were advanced age, hematologic malignancies, greater disease burden, high temperature and low blood pressure on admission, pneumonia, i.v.…”

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Risk Models for Predicting Chemotherapy-Induced Neutropenia

2005

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Neutropenia and its complications, including febrile neutropenia, are major dose-limiting toxicities of systemic cancer chemotherapy. A number of studies have attempted to identify risk factors for neutropenia and its consequences to develop predictive models capable of identifying patients at greater risk for such complications and to guide more effective and costeffective applications of the colony-stimulating factors. A systematic review of the literature showed that age, performance status, nutritional status, chemotherapy dose intensity, and low baseline blood cell counts were associated with the risk of severe and febrile neutropenia or reduced chemotherapy dose intensity in multivariate analysis in two or more studies. Similarly, age, diagnosis of leukemia or lymphoma, high temperature or low blood pressure at admission, and i.v. site infection along with low blood cell counts and organ dysfunction were associated with serious medical complications of febrile neutropenia, including bacteremia and death. The available risk model studies, however, had several limitations, including retrospective analyses of small study populations lacking independent validation, frequent missing values, and differences in the predictive factors considered. To overcome the limitations of previous studies, efforts are under way to develop and validate risk models based on large prospective studies in representative populations of patients receiving systemic chemotherapy. The

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Prognostic Factors Influencing Mortality in Cancer Patients with Neutropenia and Bacteremia

Cited by 77 publications

References 19 publications

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

Different Clinical Characteristics between Polymicrobial and Monomicrobial Aeromonas Bacteremia -A Study of 216 Cases

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

Risk Models for Predicting Chemotherapy-Induced Neutropenia

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