Gram-positive bacteraemia in granulocytopenic cancer patients

doi:10.1016/0277-5379(90)90079-9

Cited by 91 publications

(3 citation statements)

References 22 publications

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“…In alignment with epidemiologic changes showing an increase in infection by Gram-positive organisms, anti-Gram-positive antibiotics (usually vancomycin) have been incorporated in the empirical regimen (7)(8)(9). However, a meta-analysis of randomized trials comparing regimens with or without vancomycin failed to show an advantage of vancomycin in the initial empirical regimen (10,11).…”

mentioning

confidence: 99%

Shock and Early Death in Hematologic Patients with Febrile Neutropenia

Guarana

Nucci

Nouér

2019

Antimicrob Agents Chemother

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Empirical antibiotic therapy with a beta-lactam is the standard of care in febrile neutropenia (FN) and is given to prevent early death. The addition of vancomycin is recommended in certain circumstances, but the quality of evidence is low, reflecting the lack of clinical data. In order to characterize the epidemiology of early death and shock in FN, we reviewed all episodes of FN from 2003 to 2017 at University Hospital, Federal University of Rio de Janeiro, and looked at factors associated with shock at first fever and early death (within 3 days from first fever) by univariate and multivariate analyses. Among 1,305 episodes of FN, shock occurred in 42 episodes (3.2%) and early death in 15 (1.1%). Predictors of shock were bacteremia due to Escherichia coli (odds ratio [OR], 8.47; 95% confidence interval [95% CI], 4.08 to 17.55; P < 0.001), Enterobacter sp. (OR, 7.53; 95% CI, 1.60 to 35.33; P = 0.01), and Acinetobacter sp. (OR, 6.95; 95% CI, 1.49 to 32.36; P = 0.01). Factors associated with early death were non-Hodgkin’s lymphoma (OR, 3.57; 95% CI, 1.18 to 10.73; P = 0.02), pneumonia (OR, 21.36; 95% CI, 5.72 to 79.72; P < 0.001), shock (OR, 11.64: 95% CI, 2.77 to 48.86; P = 0.01), and bacteremia due to Klebsiella pneumoniae (OR, 5.91; 95% CI, 1.11 to 31.47; P = 0.03). Adequate empirical antibiotic therapy was protective (OR, 0.23; 95% CI, 0.07 to 0.81; P = 0.02). Shock or early death was not associated with Gram-positive bacteremia; catheter-related, skin, or soft tissue infection; or inadequate Gram-positive coverage. These data challenge guideline recommendations for the empirical use of vancomycin at first fever in neutropenic patients.

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confidence: 99%

Shock and Early Death in Hematologic Patients with Febrile Neutropenia

Guarana

Nucci

Nouér

2019

Antimicrob Agents Chemother

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“…E. faecalis used to be the main strain encountered even if in some centers E. faecium is replacing it. For both strains, E. faecalis and E. faecium vancomycin resistance has increased, causing a higher mortality rate [6]. Viridans streptococci are found in approximately 5% of BSI with a mortality and morbidity not negligible [4] with consequent high mortality.…”

Section: Mdr Colonization and Bsimentioning

confidence: 99%

“…Bloodstream infection (BSI) affects 11% to 40% of neutropenic patients, with an associated mortality ranging from 5% to 60% in cases of multi-drug-resistant (MDR) organisms BSI [1][2][3][4][5]. The epidemiology of BSI has undergone substantial changes in the most recent years: during the 1990s, Gram-positive BSI were the leading cause of BSI due to the increased use of intravascular devices and the extensive use of prophylaxis with fluoroquinolones (FQ) [6]. This trend was followed by the gradual rise of Gram-negative rods, with extended-spectrum beta−lactamase (ESBL), multi-drug resistance (MDR) and carbapenem-resistant Enterobacteriales (CRE) as well as MDR P. aeruginosa and Acinetobacter spp.…”

Section: Introductionmentioning

confidence: 99%

The Management of Hematologic Patients with Bloodstream Infections Due to Multi-Drug Resistant Bacteria: Where Do We Stand? From Antibacterial Prophylaxis to the Treatment of Septic Shock

Secreto

Busca

Lupia

et al. 2020

Hemato

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Bloodstream infection (BSI) and septic shock represent one of the major limiting factors for the successful treatment of patients affected by hematologic malignancies. During the most recent years we have documented a shift in the epidemiology of bacterial infections toward a consistent rise of Gram-negative rods. In addition, the emergence of multi-drug-resistant bacteria is considered a life-threatening condition requiring a multi-disciplinary approach. Aim of present review is to summarize the most recent approaches in terms of anti-microbial prophylaxis and treatment of BSI in hematologic patients with neutropenic fever.

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