A multicenter prospective study of 515 febrile neutropenia episodes in Argentina during a 5-year period

Factors Associated With Complications in Patients With Hematological Malignancies and Febrile Neutropenia: A Cohort Study

Introduction Febrile neutropenia (FN) in patients with hematological malignancy (HM) is associated with multiple hospital complications including mortality. Although different strategies for early detection and prompt treatment have been established, it is a heterogeneous population with risk factors that are difficult to detect. The data available on the prediction of such complications is limited and there lies the importance of characterizing this type of patients in our environment and evaluating the factors related to the adverse outcomes. Methods The study is a retrospective cohort study conducted at San Vicente Foundation University Hospital (HUSVF) and Alma Mater Hospital of Antioquia (HAMA) in Medellín, Colombia, between January 2018 and December 2020, including patients diagnosed with FN who presented FN at the time of diagnosis or up to 30 days after receiving chemotherapy. The main objective was to determine the factors related to mortality and severe complications (ICU admission, need for vasopressors, or need for mechanical ventilation), while the secondary objective was the microbiological characterization of this population. Results Of the 190 FN episodes, 134 (70.5%) had a clinical focus of infection. A causal agent was identified in 125 episodes (65.8%), with the majority being bacteria in 112 cases (92.6%) of the isolates. The most frequently identified bacteria were Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Gram-negative bacilli were isolated in 85 (86%) cases, and resistance was present in 38 cases (44.7%), with both extended-spectrum beta-lactamase (ESBL) and Klebsiella pneumoniae Carbapenemase (KPC) detected in nine (10.5%). In 53 (34.4%) episodes, some complications occurred during FN. The 30-day all-cause mortality was 53 (34.4%), with 27 (50.9%) of these cases associated with complications. Of the 45 (86.5%) patients who died from any cause, all did so during their first episode of FN. In the bivariate analysis, the following factors were associated with higher mortality: hypertension (OR 2.58, 95% CI 1.19-5.58; p=0.014), chronic obstructive pulmonary disease (COPD) (OR 10.2, 95% CI 1.11-93.8; p=0.013), chronic kidney disease (OR 4.27, 95% CI 0.975-18.7; p=0.038), prolonged neutropenia (OR 2.34, 95% CI 1.1-4.95; p=0.024), and lactate dehydrogenase (LDH) levels greater than two times the upper normal limit (UNL) (OR 3.24, 95% CI 1.35-7.75; p=0.007). In contrast, normal albumin levels before chemotherapy were associated with lower mortality (OR 0.381, 95% CI 0.15-0.95; p=0.036). In the multivariate analysis, none of the identified factors were statistically significant in predicting complications or mortality. Conclusion No factors related to complications or mortality were found in the multivariate analysis. However, the heterogeneity of the population suggests that these outcomes are not determined by a single factor, and a study with a larger sample may be needed to confirm them.

Mean Platelet Volume-to-Albumin Ratio as a Predictor of Mortality in Patients with Febrile Neutropenia: An Observational Study

Background and Objectives: Febrile neutropenia (FN) is a life-threatening complication in cancer patients, necessitating early risk stratification for optimal management. While the Multinational Association for Supportive Care in Cancer (MASCC) risk index is commonly used for mortality prediction, novel biomarkers that integrate inflammatory and nutritional status may improve prognostic accuracy. This study evaluates the mean platelet volume (MPV)-to-albumin (ALB) ratio as a predictor of mortality in patients with febrile neutropenia. Materials and Methods: A prospective study was conducted on patients diagnosed with febrile neutropenia. The MPV/ALB ratio was calculated at admission, and its predictive value for mortality was assessed using receiver operating characteristic (ROC) curve analysis. The results were compared with the MASCC risk index for predicting mortality both during the FN episode and within 28 days. Statistical analysis included sensitivity, specificity, and negative predictive value assessments. Results: The MPV/ALB ratio was significantly lower in non-survivors compared to survivors. A threshold of 0.245 effectively stratified patients at high risk, demonstrating strong specificity and high negative predictive value. The MPV/ALB ratio outperformed the MASCC risk index in predicting mortality during febrile neutropenia, whereas the MASCC index showed slightly better performance for 28-day mortality prediction. Conclusions: The MPV/ALB ratio is a promising biomarker for mortality prediction in febrile neutropenia, offering a simple and accessible tool for early risk assessment. Its superior performance in predicting mortality during FN highlights its potential clinical utility. Further prospective studies are needed to validate these findings and explore the integration of the MPV/ALB ratio into existing risk assessment models.

Biomarkers Affecting Treatment Outcomes of Febrile Neutropenia in Hematological Patients with Lymphomas: Is Presepsin the New Promising Diagnostic and Prognostic Biomarker?

Background/Objectives: In hematological patients receiving treatment for lymphomas, febrile neutropenia (FN) is a serious complication associated with significant morbidity and mortality. This prospective study aimed to evaluate the diagnostic and prognostic value of the novel biomarker presepsin (PSP) in episodes of FN in this specific cohort of patients. Methods: The study enrolled 37 patients with FN and 18 patients with neutropenia without fever as a control group. Patients with FN were divided into two groups: those with confirmed infections and those without them. Various clinical and laboratory parameters were analyzed, including inflammatory and biochemical markers, focusing on implications of PSP. Results: Among patients with FN, 65% had proven infections with significantly higher PSP levels compared to those without infections and control group (p < 0.001). Positive blood cultures were found in 13.5% of all FN episodes. PSP showed greater sensitivity than traditional biomarkers like procalcitonin and C-reactive protein for differentiating septic from non-septic complications. Increased PSP levels at admission suggested a poorer survival prognosis. Each 1 ng/mL increase in PSP correlated with a 5% increase in mortality risk (HR 1.05; p < 0.001), with a one-year mortality rate of 56.7%, underscoring the necessity for better predictive markers. Other markers, including CRP, PCT, IgG, and albumin, were not significantly associated with mortality; however, platelets and qSOFA exhibited borderline significance. Conclusions: PSP is a valuable biomarker for identifying high-risk FN in lymphoma patients and predicting mortality, correlating with infection severity. Larger multi-center studies are needed to validate these findings and optimize PSP's clinical application to improve outcomes.

PCT-to-albumin ratio and CRP-to-albumin ratio as predictors of febrile neutropenia complications: a prospective observational trial

PURPOSE

This study aimed to determine whether procalcitonin-to-albumin ratio (PAR) and C-reactive protein-to-albumin ratio (CAR) can be alternatives to the Multinational Association for Supportive Care in Cancer (MASCC) risk index score in predicting bacteriemia, septicemia, death during FN, and 28-day mortality, in patients with febrile neutropenia (FN).

METHODS

This is a prospective observational study that included 185 participants with FN. Clinical and laboratory findings like PAR and CAR were analyzed, and their ability to predict FN complications was investigated.

RESULTS

From the included population, the 91 subjects (49.46%) had low-risk FN with MASCC risk index ≥ 21. Sixteen participants (8.70%) had bacteremia, and eight developed septicemia (4.89%). Before resolving FN, 15 people died, and in total 33 died within 28 days of diagnosis. The ROC curve analysis indicates that the CAR (p = 0.0008921) better predicts mortality during FN, and the PAR (p = 0.0003535) better predicts bacteremia. Incorporating CAR values into the MASCC risk index predicts mortality by as much as 33.33% more precisely than the MASCC risk index alone. The CAR values > 2.74 were an independent predictor of 28-day mortality (OR = 3.70; 95% CI = 1.08-13.02; p = 0.0376).

CONCLUSION

The study results suggest that PAR and CAR can be leveraged as valuable prognostic tools in predicting bacteremia, septicemia, mortality during FN, and 28-day mortality in patients with FN.

Evaluation of the effects of regulatory T cells on survival outcomes in patients with acute leukemia who developed febrile neutropenia

ObjectivesAcute leukemia often leads to severe complications such as febrile neutropenia. Mortality rates remain high, underscoring the need for novel prognostic markers. Regulatory T cells (Tregs) have not been extensively studied in this context.MethodsThis prospective observational, single-center study included 114 patients diagnosed with acute leukemia. Tregs percentages were measured using flow cytometry. Statistical analyses involved logistic regression to identify factors significantly associated with survival.ResultsOf the 114 patients, 78 recovered, while 36 died. The median Treg percentages were 5.9% in patients under 65 years and 5.38% in those 65 and older. A lower percentage of Tregs was associated with higher mortality in the older group (p = 0.04). Multivariate analysis highlighted the presence of comorbidities, documented infections, and day seven C-reactive protein levels as significant predictors of survival.ConclusionThis study supports the importance of monitoring chronic diseases and infection foci alongside traditional markers like C-reactive protein. Future research should explore the mechanistic roles of Tregs in immunosuppression and survival in this vulnerable population.

Serum Albumin as a Prognostic Biomarker for Febrile Neutropenia Outcome and Complications: A Prospective Observational Trial

Background

Febrile neutropenia (FN) poses a significant challenge in cancer treatment, with a high incidence among patients undergoing standard therapies. Predicting FN complications and outcomes remains crucial for improving patient management strategies. Biomarkers, including procalcitonin and albumin, have garnered attention for their potential prognostic value in FN.

Methods

We conducted a prospective observational study at a tertiary hospital, enrolling 185 adult cancer patients experiencing FN episodes. We assessed serum albumin levels and incorporated them into the Multinational Association for Supportive Care in Cancer (MASCC) risk index to enhance risk stratification.

Results

Serum albumin levels displayed promising prognostic utility in febrile neutropenia (FN). They exhibited moderate specificity and sensitivity in predicting mortality during FN and 28-day mortality. Serum albumin levels were significantly associated with gastrointestinal infections, serving as an independent predictor. Integrating serum albumin into the MASCC risk index improved predictive accuracy for FN mortality by 50%, 28-day mortality by 66.67%, and respiratory tract infections by 62.50%, enhancing in this way risk stratification for FN-related complications.

Conclusion

Serum albumin emerges as a promising biomarker for prognostication in FN, complementing existing risk assessment frameworks. Its incorporation into the MASCC risk index enhances predictive capabilities, aiding clinicians in identifying high-risk patients promptly. While albumin shows potential in predicting mortality and complications, further research is warranted to optimize sensitivity and specificity, ensuring its clinical utility.

Variation in Antibiotic Prescription in High-Risk Febrile Neutropenia in Portuguese Hospitals

INTRODUCTION

Febrile neutropenia (FN) is a potentially severe entity, particularly in hemato-oncologic patients who have higher incidence of colonization with multidrug-resistant bacteria. Discrepancies among guidelines contribute to divergence in antimicrobial practices. Our objective was to assess the variation of practices in antimicrobial therapy in high-risk FN among Portuguese hematologists.

METHODS

We conducted a cross-sectional study through the implementation of an online survey, open to all clinical hematologists in the country. To characterize practice patterns regarding critical elements in FN management, three clinical vignettes were designed to describe typical situations where narrow-spectrum empiric antibiotics (vignette 1), short-course therapy (vignette 2) and de-escalation (vignette 3) could be performed. The remaining questions characterized clinical experience, department size, and differentiation and decision-making process regarding FN antibiotic therapy.

RESULTS

The survey yielded 31 responses from 11 hospitals across four regions. All respondents opted for empiric narrow-spectrum antibiotics, 22.6% opted for short-course therapy (mostly senior specialists from larger settings) and 35.5% for de-escalation (mostly young specialists). Availability of an FN protocol seemed to favor both approaches. These findings should be complemented by qualitative assessments of barriers to best practices and should support the need for interventions to improve antibiotic use in febrile neutropenia.

Knowledge, Attitude, and Practice in Preventing Infection Among Patients With Cancer Receiving Chemotherapy

BACKGROUND

Oncology patients receiving chemotherapy are at a high risk for developing infections. Identifying factors that predict infection practices among these patients can help improve the quality of care provided.

PURPOSE

The purpose of this study was to evaluate the knowledge, attitudes, and practices related to infection prevention in oncology patients receiving chemotherapy.

METHODS

A cross-sectional study was conducted among 170 patients with cancer.

RESULTS

The majority of participants had a low to moderate level of knowledge, with high levels of attitude and practice related to infection prevention. Knowledge was a significant predictor of attitude and practice, while attitude was a predictor of infection prevention practices. Knowledge and attitude emerged as mutual predictors, which could explain 23% of the variation in practice toward infection prevention (R2 = 0.230, P = .00).

CONCLUSIONS

Findings indicated that both knowledge and attitude were powerful predictors of practice toward infection prevention.

An Emergent Change in Epidemiologic and Microbiological Characteristics of Bloodstream Infections in Adults With Febrile Neutropenia Resulting From Chemotherapy for Acute Leukemia and Lymphoma at Reference Centers in Chile, Ecuador, and Peru

Background

Febrile neutropenia is a life-threatening condition commonly observed in patients with hematologic malignancies. The aim of this article is to provide updated knowledge about bloodstream infections in febrile neutropenia episodes within the Andean region of Latin America.

Method

This retrospective study was based in 6 hospitals in Chile, Ecuador, and Peru and included adult patients with acute leukemia or lymphoma and febrile neutropenia between January 2019 and December 2020.

Results

Of the 416 febrile neutropenia episodes, 38.7% had a bloodstream infection, 86% of which were caused by gram-negative rods, with Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa being the most frequently identified bacteria. K pneumoniae isolates were more frequently resistant than E coli to cefotaxime (65% vs 39.6%), piperacillin-tazobactam (56.7% vs 27.1%), and imipenem (35% vs 2.1%) and were more frequently multidrug resistant (61.7% vs 12.5%). Among P aeruginosa, 26.7% were resistant to ceftazidime, piperacillin-tazobactam, and imipenem, and 23.3% were multidrug resistant. Overall 30-day mortality was 19.8%, being higher with vs without a bloodstream infection (26.7% vs 15.3%, P = .005). Fever duration was also significantly longer, as well as periods of neutropenia and length of hospital stay for patients with bloodstream infection. Additionally, the 30-day mortality rate was higher for episodes with inappropriate vs appropriate empirical antibiotic therapy (41.2% vs 26.6%, P = .139).

Conclusions

Considering the high rates of bacteria-resistant infection and 30-day mortality, it is imperative to establish strategies that reduce the frequency of bloodstream infections, increasing early identification of patients at higher risks of multidrug bacteria resistance, and updating existing empirical antibiotic recommendations.

Dissecting bloodstream infections in febrile neutropenic patients with hematological malignancies, a decade-long single center retrospective observational study (2009-2019)

BACKGROUND

The use of ill-suited antibiotics is a significant risk factor behind the increase in the mortality, morbidity, and economic burden for patients who are under treatment for hematological malignancy (HM) and bloodstream infections (BSI). Such unfitting treatment choices intensify the evolution of resistant variants which is a public health concern due to possible healthcare-associated infection spread to the general population. Hence, this study aims to evaluate antibiograms of patients with BSI and risk factors associated with septicemia.

METHODS

A total of 1166 febrile neutropenia episodes (FNE) among 513 patients with HM from the National Center for Cancer Care and Research (NCCCR), Qatar, during 2009-2019 were used for this study. The socio-demographic, clinical, microbial, and anti-microbial data retrieved from the patient's health records were used.

RESULTS

We analyzed the sensitivity of gram-negative and gram-positive bacilli reported in HM-FN-BSI patients. Out of the total 512 microorganisms isolated, 416 (81%) were gram-negative bacteria (GNB), 76 (15%) were gram-positive bacteria (GPB) and 20 (4%) were fungi. Furthermore, in 416 GNB, 298 (71.6%) were Enterobacteriaceae sp. among which 121 (41%) were ESBL (Extended Spectrum Beta-Lactamase) resistant to Cephalosporine third generation and Piperacillin-Tazobactam, 54 (18%) were Carbapenem-resistant or multidrug-resistant organism (MDRO). It's noteworthy that the predominant infectious agents in our hospital include E. coli, Klebsiella species, and P. aeruginosa. Throughout the study period, the mortality rate due to BSI was 23%. Risk factors that show a significant correlation with death are age, disease status, mono or polymicrobial BSI and septic shock.

CONCLUSION

Decision pertaining to the usage of antimicrobials for HM-FN-BSI patients is a critical task that relies on the latest pattern of prevalence, treatment resistance, and clinical outcomes. Analysis of the antibiogram of HM-FN-BSI patients in Qatar calls for a reconsideration of currently followed empirical antibiotic therapy towards better infection control and antimicrobial stewardship.

All-Cause Mortality and Its Predictors in Haemato-Oncology Patients with Febrile Neutropenia

Febrile neutropenia (FN) is one of the most important life-threatening complications in haemato-oncology. Our objective was to report all-cause mortality rates in patients ill with a hematological malignancy (HM) hospitalized with a first FN episode and to identify predictors for mortality. We conducted a historical retrospective cohort study of consecutive patients with an HM, >18 years of age, admitted between January 2012 and August 2018 for a first episode of FN. Data on all-cause mortality 12 months after admission for FN were obtained. The Kaplan-Meier curve was used to describe mortality during the follow-up period. Univariate and multivariable analyses identified predictors for 1,3 and 12-month mortality. One hundred and fifty-eight patients (mean age 69.5, 49.4% males) were included. Overall, 54 patients died (15.8%, 25.9%, and 34.1% died after 1, 3, and 12 months, respectively). Lower serum albumin, higher serum gamma-glutamyl transferase (GGT), lower estimated glomerular filtration rate (eGFR), older age, higher temperature, and lower absolute lymphocyte count at admission were independent predictors of all-cause mortality after 12 months. Further studies are needed to confirm our results and identify therapeutic strategies to improve survival.

Epidemiology and source of infection in cancer patients with febrile neutropenia: an experience from a developing country

BACKGROUND

Febrile neutropenia (FN) is a life-threatening complication that predisposes cancer patients to serious infections. This study aims to describe the epidemiology and source of infection in cancer patients with FN in a tertiary care hospital.

METHODS

A hospital-based retrospective study was conducted in a large tertiary care hospital from January 2020 to December 2021. Data on cancer patients with FN were collected from the hospital information system.

RESULTS

150 cancer patients with FN were identified during the study period. Most patients were males (98; 65.3%), and the mean age of participants was 42.2 ± 16.0 years. Most patients (127; 84.7%) had hematologic malignancies, and acute myeloid leukemia was the most common diagnosis (42; 28%), followed by acute lymphocytic leukemia (28; 18.7%) and Hodgkin's lymphoma (20; 13.3%). Fifty-four (36%) patients had a median Multinational Association for Supportive Care in Cancer (MASCC) scores greater than 21. Regarding the outcome, nine (6%) died, and 141(94%) were discharged. The focus of fever was unknown in most patients (108; 72%). Among the known origins of fever were colitis (12; 8%), pneumonia (8; 5.3%), cellulitis (6; 4%), bloodstream infections (7; 4.6%), perianal abscess (2; 1.3%) and others. The median duration of fever was two days, and the median duration of neutropenia was seven days. Sixty-three (42%) patients had infections: 56 (73.3%) were bacterial, four (2.6%) were viral, two (1%) were fungal and 1 (0.7%) was parasitic. Among the bacterial causes, 50 cases (89.2%) were culture-positive. Among the culture-positive cases, 34 (68%) were gram-positive and 22 (44%) were gram-negative. The most frequent gram-positive bacteria were E. faecalis (9; 18% of culture-positive cases), and the most frequent gram-negative organisms were Klebsiella pneumoniae (5; 10%). Levofloxacin was the most commonly used prophylactic antibiotic (23; 15.33%), followed by acyclovir (1610.7%) and fluconazole in 15 patients (10%). Amikacin was the most popular empiric therapy, followed by piperacillin/tazobactam (74; 49.3%), ceftazidime (70; 46.7%), and vancomycin (63; 42%). One-third of E. faecalis isolates were resistant to ampicillin. Approximately two-thirds of Klebsiella pneumoniae isolates were resistant to piperacillin/tazobactam and ceftazidime. Amikacin resistance was proven in 20% of isolates.

CONCLUSIONS

The majority of patients suffered from hematologic malignancies. Less than half of the patients had infections, and the majority were bacterial. Gram-positive bacteria comprised two-thirds of cases. Therefore, empiric therapy was appropriate and in accordance with the antibiogram of the isolated bacteria.

Bacterial spectrum and antimicrobial resistance pattern in cancer patients with febrile neutropenia

BACKGROUND

Bloodstream infections are serious complications in neutropenic cancer patients. There has been a universal pickup in multidrug resistant (MDR) strains. For individuals who are at high risk for infections caused by MDR bacteria, a novel de-escalation strategy has been developed. Determine the bacterial spectrum and antibiotic resistance pattern in febrile neutropenic cancer patients was the goal of this investigation.

MATERIALS AND METHODS

From 2019 to 2020, 60 cancer patients with febrile neutropenia who were sent to Isfahan's Omid Hospital were included in this retrospective analysis. Experiments were done on the antimicrobial susceptibility of isolated bacterial infections.

RESULTS

The patients' average age was 43.35±15.59 years. Ninety-one percent (55/61) of the 60 patients had hematologic malignancies, and 8.3 percent (5/61) had solid tumors. The majority of the germs were gram-negative bacteria (66.7 percent). E. coli was the pathogen that was isolated the most frequently (26.7%), followed by Klebsiella (16.7 percent). In addition, the most prevalent identified Gram-positive bacteria was Staphylococcus epidermidis (21.7 percent). Third-generation cephalosporin (ESBL-E) resistance was present in 50% of E. coli, along with 50% resistance to cotrimoxazole, ciprofloxacin, and piperacillin, 31% resistance to amikacin, and 20% resistance to meropenem (CRE). They had an 80% sensitivity to amikacin and a 70% sensitivity to ciprofloxacin. Ten percent of our patients had antibiotic resistance in the antibiogram (XDR).

CONCLUSION

In summary, most bacterial infections were resistant to different medications. The emergence and spread of Gram-negative bacteria that are resistant to antibiotics can be stopped by prudent antibiotic use.

Underrepresentation of women in randomized controlled trials: a systematic review and meta-analysis

BACKGROUND

Although regulatory changes towards correcting the underrepresentation of women in randomized controlled trials (RCTs) occurred (National Institutes of Health 1994), concerns exist about whether an improvement is taking place. In this systematic review and meta-analysis, we aimed to assess the inclusion rates of women in recent RCTs and to explore the potential barriers for the enrollment of women.

METHODS

RCTs published in 2017 examining any type of intervention in adults were searched in PubMed and Cochrane Library. The following predefined medical fields were included: cardiovascular diseases, neoplasms, endocrine system diseases, respiratory tract diseases, bacterial and fungal infections, viral diseases, digestive system diseases, and immune system diseases. Studies were screened independently by two reviewers, and an equal number of studies was randomly selected per calendric month. The primary outcome was the enrollment rate of women, calculated as the number of randomized women patients divided by the total number of randomized patients. Rates were weighted by their inverse variance; statistical significance was tested using general linear models (GLM).

RESULTS

Out of 398 RCTs assessed for eligibility, 300 RCTs were included. The enrollment rate of women in all the examined fields was lower than 50%, except for immune system diseases [median enrollment rate of 68% (IQR 46 to 81)]. The overall median enrollment rate of women was 41% (IQR 27 to 54). The median enrollment rate of women decreased with older age of the trials' participants [mean age of trials' participants ≤ 45 years: 47% (IQR 30-64), 46-55 years: 46% (IQR 33-58), 56-62 years: 38% (IQR 27-50), ≥ 63 years: 33% (IQR 20-46), p < 0.001]. Methodological quality characteristics showed no significant association with the enrollment rates of women. Out of the 300 included RCTs, eleven did not report on the number of included women. There was no significant difference between these studies and the studies included in the analysis.

CONCLUSIONS

Women are being inadequately represented, in the selected medical fields analyzed in our study, in recent RCTs. Older age is a potential barrier for the enrollment of women in clinical trials. Low inclusion rates of elderly women might create a lack of crucial knowledge in the adverse effects and the benefit/risk profile of any given treatment. Factors that might hinder the participation of women should be sought and addressed in the design of the study.

Clinical factors predictive of recurrent febrile neutropenia in adult patients with acute leukemia

Febrile neutropenia (FN) is considered an oncologic emergency in acute leukemia. There were 250 FN events in 124 hospitalized patients with hematologic malignancy. These data imply that two FN events may occur per patient, yet data on the prevalence, risk factors, and outcomes of recurrent FN in adult patients with leukemia are limited. A retrospective cohort study was conducted that enrolled adult patients diagnosed with acute leukemia who developed FN. The eligible patients were categorized as with or without recurrent FN. A stepwise, multivariate logistic regression analysis was performed to identify predictors of recurrent FN. A total of 203 patients met the study criteria; of these, 46 (22.66%) had recurrent FN, and this group had a median of three recurrent FN emergencies. After adjusted, three independent factors remained in the final model including ALL, FN at admission, and treatment with idarubicin (3 days) and cytarabine (7 days). The three factors were positively associated with recurrent FN with adjusted odds ratios of 6.253, 4.068, and 10.757, respectively. No significant differences were found between the two groups in terms of other sources of infection, other pathogens, ICU stay, hospital stay, and mortality. ALL and FN at admission and treatment with idarubicin (3 days) and cytarabine (7 days) were associated with recurrent FN in acute leukemia patients with FN. Clinical outcomes for patients with or without recurrent FN were mostly comparable; however, due to its small sample size, further studies are required to confirm the results of this study.

Remote Monitoring of Patients With Hematologic Malignancies at High Risk of Febrile Neutropenia: Exploratory Study

BACKGROUND

Febrile neutropenia is one of the most common oncologic emergencies and is associated with significant, preventable morbidity and mortality. Most patients who experience a febrile neutropenia episode are hospitalized, resulting in significant economic cost.

OBJECTIVE

This exploratory study implemented a remote monitoring system comprising a digital infrared thermometer and a pulse oximeter with the capability to notify providers in real time of abnormalities in vital signs that could suggest early clinical deterioration and thereby improve clinical outcomes.

METHODS

The remote monitoring system was implemented and compared to standard-of-care vital signs monitoring in hospitalized patients with underlying hematologic malignancies complicated by a febrile neutropenia episode in order to assess the feasibility and validity of the system. Statistical analysis was performed using the intraclass correlation coefficient (ICC) to assess the consistency between the measurements taken using traditional methods and those taken with the remote monitoring system for each of the vital sign parameters (temperature, heart rate, and oxygen saturation). A linear mixed-effects model with a random subject effect was used to estimate the variance components. Bland-Altman plots were created for the parameters to further delineate the direction of any occurring bias.

RESULTS

A total of 23 patients were enrolled in the study (mean age 56, SD 23-75 years; male patients: n=11, 47.8%). ICC analysis confirmed the high repeatability and accuracy of the heart rate assessment (ICC=0.856), acting as a supplement to remote temperature assessment. While the sensitivity and specificity for capturing tachycardia above a rate of 100 bpm were excellent (88% and 97%, respectively), the sensitivity of the remote monitoring system in capturing temperatures >37.8 °C and oxygen saturation <92% was 45% and 50%, respectively.

CONCLUSIONS

Overall, this novel approach using temperature, heart rate, and oxygen saturation assessments successfully provided real-time, clinically valuable feedback to providers. While temperature and oxygen saturation assessments lagged in terms of sensitivity compared to a standard in-hospital system, the heart rate assessment provided highly accurate complementary data. As a whole, the system provided additional information that can be applied to a clinically vulnerable population. By transitioning its application to high-risk patients in the outpatient setting, this system can help prevent additional use of health care services through early provider intervention and potentially improve outcomes.

Mortality-associated clinical risk factors in patients with febrile neutropenia: A retrospective study

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This study aimed to predict the outcomes of febrile neutropenic patients

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Septic shock, anemia, AKI, and need for mechanical ventilation were mortality risks

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Our prediction score is efficacious in discriminating mortality risk group

Objectives

Methods

Results

Conclusions

[A single-center study on the distribution and antibiotic resistance of pathogens causing bloodstream infection in adult patients with hematological disease during the period 2014-2018]

Objective: To investigate the distribution of pathogens and the antibiotic resistance profile of bloodstream infections in adult patients with hematological diseases in the period 2014-2018 to provide evidence for the rational use of antibiotics. Methods: We retrospectively analyzed the bloodstream infections in patients with hematological diseases from January 2014 to December 2018 at the institute of Hematology & Blood Diseases Hospital; this included an assessment of the clinical characteristics, distribution of pathogens, and antibiotic resistance data. Results: There were 1935 episodes of BSIs in the 1478 patients who were studied; among these, 1700 episodes occurred in the neutropenic phase. The 7-day and 30-day all-cause mortality rates were 5.5% and 8.2%, respectively. Bloodstream infection was usually accompanied by respiratory tract, perianal zone mucositis, and digestive tract symptoms; the respective proportions were 12.4%, 12.3%, and 9.1%, respectively. Total 2025 strains were isolated; 1551 (76.6%) of the pathogens were gram-negative bacteria, mainly Escherichia coli, Klebsiella pneumonia, and Pseudomonas aeruginosa; 423 (20.9%) were gram-positive bacteria, mainly Staphylococcus spp. and Streptococcus spp. Viridans; 51 (2.5%) were fungi, mainly Candida tropicalis. The resistance rates of Enterobateriaceae to piperacillin/tazobactam, carbapenems, amikacin were <10%. The resistance rates of K. pneumoniae to cefepime, piperacillin/tazobactam and meropenem increased annually. The resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam, quinolones, Aminoglycosides were <5% even when compared to carbapenems. Eleven stains of methicillin-resistant S. aureus and 1 stain of vancomycin-resistant Enterococcus faecium were detected. Conclusion: The pathogens of bloodstream infection in adult patients with hematological diseases are widely distributed. The resistance rates of different strains vary; the rates in some species had a tendency to increase. Antibiotics should be selected rationally as per the distribution of pathogens and resistance to antibiotics in different patient groups.

An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality

Antimicrobial stewardship is of major importance in patients with febrile neutropenia (FN). In this study, we aimed to investigate the trends in resistance and the relationship with mortality rates in patients with FN. The single-center surveillance data of inpatients with FN and diagnosed as microbiologically confirmed bloodstream infections (BSIs) between 2006 and 2016 were reviewed retrospectively. A total of 950 episodes in 552 patients with BSIs were analyzed. Of whom, 55.9% were male, the median age was 43 years, and 35.6% had acute myeloid leukemia. In total, 1016 microorganisms were isolated from blood cultures. Gram-negatives accounted for 42.4% (n = 403) of the episodes. Among Gram-negatives, Enterobacteriaceae accounted for 346 (86%) (E. coli, n = 197; 34% extended-spectrum β-lactamases (ESBL) producers, and Klebsiella spp., n = 120; 48.3% ESBL producers). Also, 24 (20.0%) of Klebsiella spp. had carbapenemase activity. There were 6 (5.0%) colistin-resistant Klebsiella spp. Thirteen (26.5%) of Pseudomonas spp. and 17 (60.7%) of Acinetobacter spp. had carbapenemase activity. There were 2 (5.6%) colistin-resistant Acinetobacter spp. The 30-day mortality rates were 12.0%, 21.5%, 34.6%, and 29.0% in BSIs due to Gram-positive, Gram-negative bacterial, fungal, and polymicrobial etiology respectively (p = 0.001). BSIs with ESBL-producing (p = 0.001) isolates, carbapenem (p < 0.001), and colistin-resistant isolates (p < 0.001) were associated with increased mortality risk. The tremendous rise in resistance rates among Gram-negatives is dreadfully related to increasing mortality and leads to sharp shifts toward extreme restrictions of unnecessary antibiotic uses. Antimicrobial stewardship in patients with FN requires vigilance and tailoring of treatment upon local surveillance data.