Bacteraemia in febrile neutropenic cancer patients

Klastersky, Jean; Ameye, Lieveke; Maertens, Johan; Georgala, Aspasia; Muanza, Frédérique; Aoun, Michel; Ferrant, Augustin; Rapoport, Bernardo; Rolston, Kenneth V. I.; Paesmans, Marianne

doi:10.1016/j.ijantimicag.2007.06.012

Cited by 293 publications

(201 citation statements)

References 11 publications

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“…In the current study, Gram-positive cocci accounted for 46% of isolates while only 35% of which were Gramnegative bacilli (6). Additionally, Castagnola et al (22) reported that in their study 57% and 41% of bacteremia in febrile chemotherapy-induced neutropenia were caused by Gram-positive and negative organisms respectively while in a study in Belgium, the relative frequencies of Gram-positive, Gram-negative, and polymicrobial bacteremia in the same patients were 57%, 34%, and 10%, respectively (23).…”

Section: Discussionmentioning

confidence: 92%

“…Moreover, Cattaneo et al (27) stated that their study was an evidence for an epidemiological shift from Gram-positive to negativebacteria in patients with hematological malignancies while E. coli was the most frequent organism. Also, there are other reports of emergence of Gram-negative bacteria mainly consisted of P. aeruginosa and Enterobacteriaceae which stands for nearly 50% of all documented infections (23).…”

Section: Staphymentioning

confidence: 99%

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A Population-Based Study of Bacterial Spectrum in Febrile Neutropenic Patients

Meidani

Bagheri

Khorvash

2013

Jundishapur J Microbiol

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Background: Because of great concerns about mortality and morbidity of infection in febrile neutropenic patients, the appropriate empirical antibiotic should be started immediately. Although there are established guidelines for the use of empirical therapy, local microbiological pattern and antibiotic susceptibility should be considered. Objectives: The current study aimed to identify the etiological pathogens in febrile neutropenic cancer patients in Isfahan, Iran. Patients and Methods:This single-centre population-based study was conducted on 81 febrile neutropenic patients referring to Sayed-AlShohada hospital, the only referral malignant care center in Isfahan, Iran. Demographic data, duration and kind of malignancy, duration from last chemotherapy, duration of fever, and also physical exam were recorded for each patient. Moreover, procalcitonin, CRP, ESR, white blood cells, hemoglobin, platelet, and absolute neutrophil count were measured. BACTEC and E-test were used for blood culturing and determining the antibiotic susceptibility. Results: Out of 81 participants, 28.4% had positive blood cultures which mostly consisted of Gram-positive microorganisms. In addition, Staphylococcus epidermidis was the most isolated Gram positive bacteria (39.1%). ESR, CRP, and procalcitonin were significantly higher in patients with positive blood culture. The risk of infection increased with raise in duration of hospital stay, catheterization, increased pulse rate, increased oral temperature, low level of oxygen saturation, decreased systolic blood pressure, and low absolute neutrophile count. However, in this case, no relationship was found among the patients' age, diastolic blood pressure, respiratory rate, duration of diagnosis, duration from last chemotherapy, duration of fever, white blood cells, hemoglobin, platelet, and finally the type of malignancies. Conclusions: It was concluded that Gram-positive bacteria were more prevalent as a cause of infection in the patients with malignancy and the most common pathogen was S. epidermidis. Larger studies are needed to determine the bacterial susceptibility of this center.

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Section: Discussionmentioning

confidence: 92%

Section: Staphymentioning

confidence: 99%

A Population-Based Study of Bacterial Spectrum in Febrile Neutropenic Patients

Meidani

Bagheri

Khorvash

2013

Jundishapur J Microbiol

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“…[60][61][62] Usually, GP BSIs result in a lower mortality than GN ones, 43,63,64 yet the mortality rate is very variable. For instance, it can range from 4% in infections caused by coagulase-negative staphylococci to 40% in a MRSA outbreak involving early post-HSCT patients.…”

Section: Outcomementioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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“…In fact, Enterobacteriaceae are the most common causes of Gram-negative bacteremia in these patients. [49][50][51] Guidelines of the Infectious Diseases Society of America recommend that febrile neutropenic patients receive empirical antimicrobial therapy within 2 hours of presentation because outcomes are poor if effective therapy is delayed. 52 However, recommended empirical therapies, such as piperacillin-tazobactam, cefepime, and carbapenems are not active against CRE.…”

Section: Cre In Patients With Hematologic Malignancies and Haematopoimentioning

confidence: 99%

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

2016

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Carbapenem-resistant Enterobacteriaceae (CRE) are a major global public health concern and pose a serious threat to immunocompromised hosts, particularly patients with hematologic malignancies and solid organ (SOT) and stem cell transplant recipients. In endemic areas, carbapenem-resistant Klebsiella pneumoniae infections occur in 1-18% of SOT recipients, and patients with hematologic malignancies represent 16-24% of all patients with CRE bacteremia. Mortality rates approaching 60% have been reported in these patient populations. Early diagnosis and rapid initiation of targeted therapy is critical in the management of immunocompromised hosts with CRE infections, as recommended empiric regimens are not active against CRE. Therapeutic options are limited by antibiotic-associated toxicities, interactions with immunosuppressive agents, and paucity of antibiotic options currently available. Prevention of CRE infection in these patients requires a multidisciplinary approach involving hospital epidemiology and antimicrobial stewardship. Large, multicenter studies are needed to develop risk-stratification tools to assist in guiding the management of these individuals.

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Bacteraemia in febrile neutropenic cancer patients

Cited by 293 publications

References 11 publications

A Population-Based Study of Bacterial Spectrum in Febrile Neutropenic Patients

A Population-Based Study of Bacterial Spectrum in Febrile Neutropenic Patients

Bloodstream infections in neutropenic cancer patients: A practical update

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

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