Evaluation of Bloodstream Infections during Chemotherapy-Induced Febrile Neutropenia in Patients with Malignant Hematological Diseases: Single Center Experience

Piukovics, Klára; Terhes, Gabriella; Lázár, Andrea; Tímár, Flóra; Borbényi, Zita; Urbán, Edit

doi:10.1556/1886.2015.00021

Cited by 19 publications

(28 citation statements)

References 19 publications

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“…Regarding causes of fever, it is noteworthy that 42.5% of all febrile episodes were of unknown origin, a concept modified by Engelhart et al that means "fever without evidence of a specific infection at any site, without isolation of a specific microorganism from body specimens or without any apparent non-infectious cause" [6]. This number is comparable with the findings of Burutaran et al, who found a prevalence of 38% of fever or unknown origin [9], and with a prevalence of 53% described by Piukovics et al [10]. Studies suggest that at least half of all neutropenic patients with fever of unknown origin have an occult infection, underlining the relevance of this entity [6].…”

Section: Discussionsupporting

confidence: 72%

“…Our study shows that almost 35% of all hospitalizations in a hematology-oncology clinic of a portuguese oncology hospital were complicated by fever. Hungarian hospital [10].…”

Section: Discussionmentioning

confidence: 99%

“…Few recent works studied the prevalence and causes of fever in hematology-oncology patients [7], and most of them focused on fever in neutropenic patients [6] [8] [9] [10]. We hypothesize that most febrile episodes in this population are secondary to infection.…”

Section: Introductionmentioning

confidence: 99%

“…In endothermic animals, it happens at the expense of high metabolic rates, with an increment of 10% to 12.5% for each degree Celsius above normal [1]. This mechanism allows for a better immune system activation and inhibi-DOI: 10.4236/jct.2018.93020 232 Journal of Cancer Therapy tion of bacteria and viruses replication [2]. A corollary of fever benefits is its preservation throughout the evolution of species [3].…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesize that most febrile episodes in this population are secondary to infection. Since infection alone appears to worsen prognosis by raising mortality or by requiring chemotherapy adjustments or suspension [10], knowing fever prevalence in this group of patients is of great importance.…”

Section: Introductionmentioning

confidence: 99%

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Fever and Infection Prevalence in Hematology-Oncology Hospitalized Patients: A Single-Center Retrospective Study

Costa¹,

Chacim²,

Mariz³

2018

JCT

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Fever is prevalent in hospitalized patients. In hematology-oncology patients, it is related with infection, a disease manifestation or a consequence of immunological dysfunction. This single-center retrospective study aims to determine fever prevalence, describe its causes and evaluate the impact of infection on mortality. We reviewed clinical records of 222 patients admitted to the hospital in three random months of 2015. Around 35% of all hospitalizations were complicated by fever, 42.5% of unknown origin. 90.4% were under treatment. Around 81% did antibiotics, most commonly piperacillin/tazobactam, for around 11 days. 41% changed antibiotics due to fever persistence or microbiological results. The diagnostic yield of microbiological tests was 25%; in 66.7%, a Gram-negative microorganism was isolated. We didn't find an association between infection and mortality. We conclude that fever is common in our hematology-oncology clinic and that the team is trained to assume infection; empirical treatment is in accordance with international recommendations.

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Section: Discussionsupporting

confidence: 72%

“…Our study shows that almost 35% of all hospitalizations in a hematology-oncology clinic of a portuguese oncology hospital were complicated by fever. Hungarian hospital [10].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Fever and Infection Prevalence in Hematology-Oncology Hospitalized Patients: A Single-Center Retrospective Study

Costa¹,

Chacim²,

Mariz³

2018

JCT

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Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

et al. 2023

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Background It is unknown whether serum procalcitonin (PCT) concentration monitoring can differentiate between bacterial infection or cytokine release syndrome (CRS) when chimeric antigen receptor T‐cell (CAR‐T) recipients present with a constellation of signs and symptoms that may represent both complications. Objective The objective of the study was to assess the utility of serum PCT concentrations as a biomarker of bacterial infection in CAR‐T recipients. Study design This single‐center, retrospective, medical record review evaluated patients prescribed CAR‐T therapy until death or 30 days after infusion. Logistic regression modeling determined the association between elevated serum PCT concentrations within 48 h of fever onset and microbiologically confirmed infection. Secondary outcomes included clinically suspected infection, CAR‐T toxicity rates, and broad‐spectrum antibiotic usage. Predictive performance of PCT was assessed by area under the receiver operating characteristic curve (AUC). Results The 98 included patients were a median age of 63 (IQR: 55–69) years old, 47 (48%) were male, and 87 (89%) were Caucasian. Baseline demographics and clinical characteristics were similar between patients with and without a bacterial infection. Serum PCT >0.4 ng/mL within 48 h of fever was significantly associated with a microbiologically confirmed bacterial infection (OR: 2.75 [95% CI: 1.02–7.39], p = 0.045). Median PCT values in patients with and without confirmed infections were 0.40 ng/mL (IQR: 0.26, 0.74) and 0.26 ng/mL (IQR: 0.13, 0.47), respectively. The AUC for PCT to predict bacterial infection was 0.62 (95% CI 0.48–0.76). All patients experienced CRS of some grade, with no difference in CRS severity based on elevated PCT. Broad‐spectrum antibiotics were used for a median of 45% and 23% of days in those with and without confirmed infection, respectively ( p = 0.075). Conclusion Elevated serum PCT concentrations above 0.4 ng/mL at time of first fever after CAR‐T infusion was significantly associated with confirmed bacterial infection. Furthermore, rigorous, prospective studies should validate our findings and evaluate serial PCT measurements to optimize antimicrobial use after CAR‐T therapy.

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Viridans group streptococci bloodstream infections in neutropenic adult patients with hematologic malignancy: Single center experience

et al. 2017

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Viridans group streptococci bloodstream infections (VGS BSI) remain a significant cause of mortality and morbidity in patients with severe neutropenia. The goal of our study was to evaluate clinical course and microbiological susceptibility of VGS BSI at our center. Retrospective analysis of all microbiologically documented bloodstream infections caused by VGS during the 9-year time period (from January 2006 until December 2014) was carried out. Only patients with severe neutropenia (< 500/μL) were included in the study. Clinical outcome and microbiological susceptibility pattern of isolates were recorded. Fifty-one individual patients with episode of VGS BSI were identified. The most frequent agent was Streptococcus mitis (23/51 cases, 45.1%). 88.2% (45/51) of patients were on recommended ciprofloxacin prophylaxis. 20/51 (39.2%) of patients suffered from mucositis at the time of diagnosis (10 patients had oral mucositis, 2 patients had bowel mucositis, and 8 patients both). Twenty-six patients (51.0%) had clinically relevant lung damage caused by VGS BSI (i.e., acute lung injury or acute respiratory distress syndrome). Twenty-four (47.0%) patients presented with bilateral lung infiltrated upon chest imaging, and two (4.0%) patients had unilateral lung infiltrates. Three patients (5.9%) died due to VGS BSI until day 28 of observation. No difference in signs of shock syndrome was observed in the patients during transplantation procedures compared to patients without transplantation as well as in a group received previous high-dose chemotherapy with cytosinarabinoside or in patients with mucositis. Only 3/51 of isolates (5.9%) were resistant to penicillin. All isolates were susceptible to empirical treatment. While the penicillin resistance of VGS remains low in middle Europe, initial antibiotic therapy of febrile neutropenia are still effective in most cases. The mortality and complication rates of VGS BSI were comparable to other studies, and no specific risk factor of shock presence could be identified.

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Evaluation of Bloodstream Infections during Chemotherapy-Induced Febrile Neutropenia in Patients with Malignant Hematological Diseases: Single Center Experience

Cited by 19 publications

References 19 publications

Fever and Infection Prevalence in Hematology-Oncology Hospitalized Patients: A Single-Center Retrospective Study

Fever and Infection Prevalence in Hematology-Oncology Hospitalized Patients: A Single-Center Retrospective Study

Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

Viridans group streptococci bloodstream infections in neutropenic adult patients with hematologic malignancy: Single center experience

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