Microbiological Findings in Febrile Neutropenia

Gaytán-Martı́nez, Jesús; Mateos-García, Eduardo; Sánchez-Cortés, Evelia; González-Llaven, J; Casanova-Cardiel, Luis; Fuentes-Allen, José Luis

doi:10.1016/s0188-4409(00)00080-1

Cited by 81 publications

(52 citation statements)

References 16 publications

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“…However, some authors reported an increase in Gramnegative bacteremia despite use of quinolone prophylaxis. 22 The use of quinolone prophylaxis in the present study reduced by 85% the risk of developing fever. The other variable associated with a reduction in the risk of developing fever during the neutropenia was non-myeloablative HSCT.…”

Section: S R Nt S R Nt S R Nt S R Nt S R Nt S R Ntmentioning

confidence: 50%

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Oliveira

Souza

Carvalho-Dias

et al. 2007

Bone Marrow Transplant

148

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The incidence of Gram-negative bacteremia has increased in hematopoietic stem cell transplant (HSCT) recipients. We prospectively collected data from 13 Brazilian HSCT centers to characterize the epidemiology of bacteremia occurring early post transplant, and to identify factors associated with infection due to multi-drug-resistant (MDR) Gram-negative isolates. MDR was defined as an isolate with resistance to at least two of the following: third-or fourth-generation cephalosporins, carbapenems or piperacillin-tazobactam. Among 411 HSCT, fever occurred in 333, and 91 developed bacteremia (118 isolates): 47% owing to Gram-positive, 37% owing to Gram-negative, and 16% caused by Gram-positive and Gram-negative bacteria. Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%) and Escherichia coli (17%) accounted for the majority of Gram-negative isolates, and 37% were MDR. These isolates were recovered from 20 patients, representing 5% of all 411 HSCT and 22% of the episodes with bacteremia. By multivariate analysis, treatment with third-generation cephalosporins (odds ratio (OR) 10.65, 95% confidence interval (CI) 3. 75-30.27) and being at one of the hospitals (OR 9.47, 95% CI 2.60-34.40) were associated with infection due to MDR Gram-negative isolates. These findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen.

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Section: S R Nt S R Nt S R Nt S R Nt S R Nt S R Ntmentioning

confidence: 50%

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Oliveira

Souza

Carvalho-Dias

et al. 2007

Bone Marrow Transplant

148

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“…11,14,16,19,27,29,35,36,39 Haematological malignancies represented the main cause of neutropenia; seven studies included also patients with solid cancer (ranging from 5% to 44% of the patient population). Acute leukaemia was the most common haematological disease in 17 (57%) studies.…”

Section: 39mentioning

confidence: 99%

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

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Background: Carbapenem-resistant Gram-negative bacteria are recognized as a cause of difficult-to-treat infections associated with high mortality.Objectives: To perform a systematic review of currently available data on distribution, characteristics and outcome associated with carbapenem-resistant bloodstream infections in adult neutropenic patients.Methods: Included studies were identified through Medline, Embase and Cochrane databases between January 1995 and April 2016. Random effect meta-analysis was used to quantify the association between carbapenem resistance and mortality and between carbapenem exposure and resistance.Results: A total of 30 studies from 21 countries were included. Overall carbapenem resistance varied from 2% to 53% (median 9%) among studies. Infections due to carbapenem-resistant Pseudomonas spp. were reported in 18 (60%) studies showing high median resistance rates (44% of all carbapenem-resistant Gram-negatives and 19% of Pseudomonas isolates). Resistance of Enterobacteriaceae was less commonly reported and bloodstream infections due to carbapenem-resistant Klebsiella spp. were mainly documented from endemic areas (Greece, Italy, Israel). Carbapenem resistance in Acinetobacter spp. was reported in 9 (30%) studies (median resistance 58% of Acinetobacter isolates). Mortality rates ranged from 33% to 71% (median 50%) in patients with carbapenem-resistant infections. Carbapenem resistance appeared to correlate with mortality (OR 4.89,) and previous exposure to carbapenems (OR 4.63,.Conclusions: Carbapenem resistance represents a threat to neutropenic patients. In this group, resistance is likely promoted by previous carbapenem use and leads to high mortality rates. The knowledge of resistance patterns is crucial and can direct clinicians in the use of alternatives to carbapenem-based regimens.

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“…Kandemir ve arkadaşları, 81 febril nötropeni atağını değerlendirdikleri çalışmada enfeksiyonların %41'ini klinik olarak, %28'ini mikrobiyolojik olarak tanımlamışlar, %31'inde ateşin nedenini bulamadıklarını bildirmişlerdir [3] . Son yıllarda yapılan bazı çalışmalarda gram-negatif bakterilerin sıklığında yeniden bir artış gözlendiği de bildirilmektedir [18,19] .…”

Section: Discussionunclassified

“…Gram-negatiflerden en sık E. coli (%28), gram-pozitiflerden koagülaz negatif stafilokok (%14) izole edilmiştir. Gaytan-Martinez ve arkadaşları da %33 oranıyla en sık E. coli, ikinci sırada koagülaz-negatif stafilokok (%29) izole etmişlerdir [3,18] .…”

Section: Discussionunclassified

Evaluation of Febrile Neutropenia in Hematologic Malignancy Patients

Aslan¹,

Oz²,

Akay³

et al. 2014

Mediterr J Infect Microb Antimicrob

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ÖZETGiriş: Hematolojik malignite hastalarında gelişen febril nötropeni, hastanede yatış gerektiren ve ölümle sonuçlanabilen en sık komplikasyondur. Nedeni açıklanana kadar enfeksiyona bağlı olduğu kabul edilir. Bu nedenle multidisipliner yaklaşım gerektirmekte ve medikal bir acil olarak tedavi edilmektedir. Güncel tedavi yaklaşımlarıyla enfeksiyona bağlı ölüm oranları azaltılmaya çalışılmaktadır. Bu çalışmada merkezimizde takip edilen hematolojik maligniteli febril nötropenik hastaların klinik özelliklerinin, risk faktörlerinin, izole edilen patojenlerin dağılımının ve mortalite üzerine etkili faktörlerin prospektif olarak araştırılması amaçlandı. Materyal ve Metod:Bu çalışmada Ocak 2012-Ocak 2013 tarihleri arasında hastanemizin hematoloji servisinde takip ve tedavi edilen 99 hematolojik maligniteli hastanın 161 febril nötropeni epizodu incelendi. Hastaların yaş, cinsiyet, altta yatan hastalık, aldıkları kemoterapi, takipleri sırasındaki kan sayımı sonuçları, görüntüleme yöntemlerindeki bulgular, uygulanan antibakteriyel veya antifungal tedavileri kaydedildi. Hastalardan rutin kan ve idrar kültürü, gerektiğinde diğer steril vücut sıvılarından kültür örnekleri alındı ve mikrobiyolojik açıdan incelendi. Bulgular: Çalışmaya katılan hastaların yaş ortalaması 50.7 ± 15.9 yıl olarak bulundu. Hastaların hastanede yatış süreleri ortalama 29.7 ± 14.9 gün, ortalama nötropeni süresi ise 14.6 ± 5.7 gündü. Değerlendirilen epizodların, %21'inde mikrobiyolojik olarak kanıtlanmış enfeksiyon, %40'ında klinik olarak saptanmış enfeksiyon, %39'unda ise nedeni bilinmeyen ateş saptandı. Toplam 47 izolat elde edildi. İzole edilen mikroorganizmaların dağılımları değerlendirildiğinde; tüm kültürlerde %40 gram-pozitif, %47 gramnegatif, %13 mantar üremesi saptandı. En sık saptanan mikroorganizmalar; %31 ile koagülaz-negatif stafilokok ve %22 ile Escherichia coli idi. Kan kültürlerinde ise %58 gram-pozitif bakteriler, %32 gram-negatif bakteriler ve %10 mantar üremesi vardı.

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Microbiological Findings in Febrile Neutropenia

Cited by 81 publications

References 16 publications

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Evaluation of Febrile Neutropenia in Hematologic Malignancy Patients

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