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Erdem H, Kocoglu E, Ankarali H, El-Sokkary R, Hakamifard A, Karaali R, Kulzhanova S, El-Kholy A, Tehrani HA, Khedr R, Kaya-Kalem A, Pandak N, Cagla-Sonmezer M, Nizamuddin S, Berk-Cam H, Guner R, Elkholy JA, Llopis F, Marino A, Stebel R, Szabo BG, Belitova M, Fadel E, Yetisyigit T, Cag Y, Alkan S, Kayaaslan B, Oncu S, Ozdemir M, Yilmaz M, Isik AC, Başkol D, Sincan G, Cascio A, Ozer-Balin S, Korkmaz N, Ripon RK, Abbas S, Dumitru IM, Eser-Karlidag G, Lanzafame M, Rafey A, Raza A, Sipahi OR, Darazam IA, Elbahr U, Erdem I, Ergen P, Bilir C, Caskurlu H, Erdem A, Makek MJ, Altindis M, Lakatos B, Luca CM, Yilmaz EM, Nsutebu E, Cakmak R, Sirmatel F. Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study. Int J Antimicrob Agents 2023; 62:106919. [PMID: 37423582 DOI: 10.1016/j.ijantimicag.2023.106919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. METHODS The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). RESULTS A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120-3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. CONCLUSIONS Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain; Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Türkiye.
| | - Esra Kocoglu
- Department of Microbiology and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ridvan Karaali
- Department of Infectious Diseases & Clinical Microbiology, Cerrahpaşa School of Medicine, Istanbul, Türkiye
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hamed Azhdari Tehrani
- Department of Haematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reham Khedr
- Department of Paediatric Oncology, National Cancer Institute-Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Ayşe Kaya-Kalem
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | | | - Meliha Cagla-Sonmezer
- Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Summiya Nizamuddin
- Section of Microbiology, Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Hande Berk-Cam
- Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Research Hospital, Antalya, Türkiye
| | - Rahmet Guner
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Jehan Ali Elkholy
- Department of Anaesthesia, Pain Management, Cairo University Hospital, Cairo, Egypt
| | - Ferran Llopis
- Emergency Department, Bellvitge University Hospital, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Roman Stebel
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Maya Belitova
- Medical University-Sofia, Department of Anaesthesiology and Intensive Care, University Hospital 'Queen Giovanna' ISUL, EAD, Sofia, Bulgaria
| | - Elias Fadel
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Tarkan Yetisyigit
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye.
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Türkiye
| | - Bircan Kayaaslan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Serkan Oncu
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Türkiye
| | - Mehmet Ozdemir
- Department of Medical Microbiology, Necmettin Erbakan University, Konya, Türkiye
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Arzu Cennet Isik
- Department of Internal Medicine, Dr. Lutfi Kirdar City Hospital, Istanbul, Türkiye
| | - Dilşah Başkol
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Gulden Sincan
- Department of Haematology, School of Medicine, Ataturk University, Erzurum, Türkiye
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Italy
| | - Safak Ozer-Balin
- Department of Infectious Diseases and Clinical Microbiology, Firat University, School of Medicine, Elazig, Türkiye
| | - Nesibe Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yıldirim Beyazit Education and Research Hospital, Ankara, Türkiye
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Salma Abbas
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | | | - Abdur Rafey
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Aun Raza
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Oguz Resat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain
| | - Ilknur Erdem
- Namık Kemal University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Tekirdağ, Türkiye
| | - Pinar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Cemil Bilir
- Department of Oncology, Istinye University, VMMedical Park Pendik Hospital, Istanbul, Türkiye; Sakarya University Faculty of Medicine Department of Medical Oncology, Sakarya, Türkiye
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Aysegul Erdem
- Department of Pathology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Mateja Jankovic Makek
- University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mustafa Altindis
- Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | | | - Esmeray Mutlu Yilmaz
- Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Türkiye
| | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, The United Arab Emirates
| | - Rumeysa Cakmak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Fatma Sirmatel
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Abant Izzet Baysal University, Bolu, Türkiye
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