Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia

被引：8

作者：

Albasanz-Puig, Adaia ^{[1
,2
]}

Dura-Miralles, Xavier ^{[1
]}

Laporte-Amargos, Julia ^{[1
]}

Mussetti, Alberto ^{[3
]}

Ruiz-Camps, Isabel ^{[2
,4
]}

Puerta-Alcalde, Pedro ^{[5
]}

Abdala, Edson ^{[6
]}

Oltolini, Chiara ^{[7
]}

Akova, Murat ^{[8
]}

Miguel Montejo, Jose ^{[9
]}

Mikulska, Malgorzata ^{[10
,11
]}

Martin-Davila, Pilar ^{[2
,12
]}

Herrera, Fabian ^{[13
]}

Gasch, Oriol ^{[14
]}

Drgona, Lubos ^{[15
,16
]}

Paz Morales, Hugo Manuel ^{[17
]}

Brunel, Anne-Sophie ^{[18
]}

Garcia, Estefania ^{[19
]}

Isler, Burcu ^{[20
]}

Kern, Winfried, V ^{[21
,22
]}

Retamar-Gentil, Pilar ^{[2
,23
]}

Maria Aguado, Jose ^{[2
,24
]}

Montero, Milagros ^{[25
]}

Kanj, Souha S. ^{[26
]}

Sipahi, Oguz R. ^{[27
]}

Calik, Sebnem ^{[28
]}

Marquez-Gomez, Ignacio ^{[29
]}

Marin, Jorge, I ^{[30
,31
]}

Gomes, Marisa Z. R. ^{[32
]}

Hemmati, Philipp ^{[33
]}

Araos, Rafael ^{[34
,35
]}

Peghin, Maddalena ^{[36
,37
]}

Luis del Pozo, Jose ^{[38
]}

Yanez, Lucrecia ^{[39
]}

Tilley, Robert ^{[40
]}

Manzur, Adriana ^{[41
]}

Novo, Andres ^{[42
]}

Pallares, Natalia ^{[43
]}

Bergas, Alba ^{[1
]}

Carratala, Jordi ^{[1
,2
]}

Gudiol, Carlota ^{[1
,2
,44
]}

机构：

[1] Univ Barcelona, Bellvitge Univ Hosp, Infect Dis Dept, IDIBELL, Barcelona 08907, Spain

[2] Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Infecciosas CI, Madrid 28029, Spain

[3] Duran i Reynals Hosp, Hematol Dept, IDIBELL, Catalan Inst Oncol ICO, Barcelona 08907, Spain

[4] Vall dHebron Univ Hosp, Infect Dis Dept, Barcelona 08035, Spain

[5] Hosp Clin Barcelona, Infect Dis Dept, Barcelona 08035, Spain

[6] Univ Sao Paulo, Fac Med, Inst Canc Estado Sao Paulo, BR-01246 Sao Paulo, Brazil

[7] IRCCS San Raffaele Sci Inst, Unit Infect & Trop Dis, I-20132 Milan, Italy

[8] Hacettepe Univ, Dept Infect Dis, Sch Med, TR-06230 Ankara, Turkey

[9] Cruces Univ Hosp, Infect Dis Dept, Bilbao 48903, Spain

[10] Univ Genoa DISSAL, Dept Hlth Sci, Div Infect Dis, I-16132 Genoa, Italy

[11] Osped Policlin San Martino, I-16132 Genoa, Italy

[12] Ramon & Cajal Hosp, Infect Dis Dept, Madrid 28034, Spain

[13] Ctr Educ Med & Invest Clin CEMIC, Dept Med, Infect Dis Sect, Buenos Aires C1430EFA, Buenos Aires, DF, Argentina

[14] Parc Tauli Univ Hosp, Infect Dis Dept, Barcelona 08208, Spain

[15] Comenius Univ, Oncohematol Dept, Bratislava 81499, Slovakia

[16] Natl Canc Inst, Bratislava 81499, Slovakia

[17] Hosp Erasto Gaertner, Infect Dis Dept, BR-81520060 Curitiba, Parana, Brazil

[18] Ctr Hosp Univ Vaudois CHUV, Lausanne Univ Hosp, Infect Dis Dept, Dept Med, CH-1011 Lausanne, Switzerland

[19] Reina Sofia Univ Hosp IMIBIC UCO, Haematol Dept, Cordoba 14004, Spain

[20] Istanbul Educ & Res Hosp, Dept Infect Dis & Clin Microbiol, TR-34668 Istanbul, Turkey

[21] Univ Freiburg Med Ctr, Dept Med 2, Div Infect Dis, D-79110 Freiburg, Germany

[22] Fac Med, D-79110 Freiburg, Germany

[23] Univ Seville, Univ Hosp Virgen Macarena,CSIC, Dept Med,Virgen Rocio & Virgen Macarena Univ Hosp, Unit Infect Dis & Microbiol,Inst Biomed Seville, Seville 41013, Spain

[24] Univ Complutense, Inst Invest Hosp 12 Octubre I 12, Sch Med, Infect Dis Unit,12 Octubre Univ Hosp, Madrid 28041, Spain

[25] Univ Autonoma Barcelona UAB, CEXS Univ Pompeu Fabra, Hosp del Mar,Infect Pathol & Antimicrobials Res G, Inst Hosp del Mar Invest Med IMIM,Infect Dis Serv, Barcelona 08003, Spain

[26] Amer Univ Beirut, Infect Dis Div, Med Ctr, Beirut 110236, Lebanon

[27] Ege Univ, Fac Med, TR-35040 Izmir, Turkey

[28] Univ Hlth Sci Izmir, Dept Infect Dis & Clin Microbiol, Bozyaka Training & Res Hosp, TR-35170 Izmir, Turkey

[29] Hosp Reg Malaga, Infect Dis Dept, Malaga 29010, Spain

[30] Clin Maraya, Infect Dis & Clin Microbiol Dept, Pereira, Colombia

[31] Crit Care & Clin Microbiol Dept, Manizales 17000117, Colombia

[32] Minist Saude, Inst Oswaldo Cruz, Hosp Fed Serv Estado, Fundacao Oswaldo Cruz, BR-20221161 Rio De Janeiro, Brazil

[33] Charite, Dept Hematol Oncol & Palliat Care, Klinikum Ernst von Bergmann, Acad Teaching Hosp, D-10117 Berlin, Germany

[34] Alemana Univ Desarrollo, Fac Med Clin, Inst Ciencias & Innovac Med, Santiago, Chile

[35] Millennium Initiat Collaborat Res Bacterial Resis, Santiago 12461, Chile

[36] Univ Udine, Dept Med, Infect Dis Clin, I-33100 Udine, Italy

[37] Azienda Sanitaria Univ Integrata, I-33100 Udine, Italy

[38] Univ Navarra, Fac Med, Infect Dis & Microbiol Unit, Pamplona 31008, Spain

[39] Marques de Valdecilla Univ Hosp, Haematol Dept, Santander 39008, Spain

[40] Univ Hosp Plymouth NHS Trust, Microbiol Dept, Plymouth 8DH, Devon, England

[41] Hosp Rawson, Infect Dis, San Juan J5400, San Juan, Argentina

[42] Son Espases Univ Hosp, Haematol Dept, Palma De Mallorca 07120, Spain

[43] Rovira & Virgili Univ, Inst Biomed Res Bellvitge, Stat Advisory Serv, Tarragona 08908, Spain

[44] Duran i Reynals Hosp, Catalan Inst Oncol ICO, Infect Dis Unit, IDIBELL, Barcelona 08908, Spain

来源：

MICROORGANISMS | 2022年 / 10卷 / 04期

关键词：

Pseudomonas aeruginosa; bloodstream infection; pneumonia; septic shock; neutropenia; INFECTIOUS-DISEASES SOCIETY; HEMATOLOGIC MALIGNANCIES; RISK-FACTORS; BACTEREMIA; GUIDELINES; MONOTHERAPY; RESISTANCE;

D O I：

10.3390/microorganisms10040733

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006-2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01-2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27-0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76-2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.

引用

页数：14

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