Carlota Gudiol1,2,3,4, Cristina Royo-Cebrecos5,6,7, Júlia Laporte5, Carmen Ardanuy8,9, Carolina Garcia-Vidal5,6,7, Maite Antonio10,11, Montserrat Arnan12,11, Jordi Carratalà5,6,7. 1. Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. cgudiol@iconcologia.net. 2. Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. cgudiol@iconcologia.net. 3. Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. cgudiol@iconcologia.net. 4. REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain. cgudiol@iconcologia.net. 5. Departments of Infectious Diseases, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 6. Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 7. REIPI (Spanish Network for Research in Infectious Diesaes), ISCIII (Carlos III Health Institute), Madrid, Spain. 8. Departments of Microbiology of Bellvitge Univesity Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 9. CIBERes (CIBEr Respiratory Diseases), ISCIII, Madrid, Spain. 10. Departments of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 11. Catalan Institute of Oncology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 12. Departments of Haematology Duran i Reynals Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Abstract
BACKGROUND AND OBJECTIVE: We aimed to assess the clinical features, aetiology and outcomes of bacteraemic pneumonia in neutropenic cancer patients (NCP) in the current era of increasing antimicrobial resistance. METHODS: All episodes of bacteraemia occurring in hospitalized patients with cancer, including haematopoietic stem cell transplant recipients, from January 2006 to April 2015 were included. RESULTS: We identified 1723 episodes of bacteraemia, of which 795 occurred in neutropenic patients with cancer, and among them, 55 episodes were identified as bacteraemic pneumonia. The most frequent causative agents were Pseudomonas aeruginosa (39.6%), Streptococcus pneumoniae (20.6%) and Escherichia coli (8.6%). Among the Gram-negative organisms, 12.8% were multidrug resistant (MDR). Eleven patients (20%) required admission to intensive care, and eight (14.8%) underwent invasive mechanical ventilation. Nine patients (16.3%) received inadequate empirical antibiotic therapy, of whom six (66.6%) died; eight of these nine patients had pneumonia caused by resistant microorganisms. The early (48 h) case-fatality rate was 24% and the overall (30 day) case-fatality rate was 46.2%. CONCLUSION: Bacteraemic pneumonia is a frequent complication among NCP and is mainly caused by P. aeruginosa and S. pneumoniae. The emergence of MDR organisms is of special concern. Despite the improvement in the management of cancer patients, case-fatality rates of NCP with bacteraemic pneumonia remain high. Urgent assessment is needed to identify a better approach for the management and support of these patients.
BACKGROUND AND OBJECTIVE: We aimed to assess the clinical features, aetiology and outcomes of bacteraemic pneumonia in neutropenic cancerpatients (NCP) in the current era of increasing antimicrobial resistance. METHODS: All episodes of bacteraemia occurring in hospitalized patients with cancer, including haematopoietic stem cell transplant recipients, from January 2006 to April 2015 were included. RESULTS: We identified 1723 episodes of bacteraemia, of which 795 occurred in neutropenicpatients with cancer, and among them, 55 episodes were identified as bacteraemic pneumonia. The most frequent causative agents were Pseudomonas aeruginosa (39.6%), Streptococcus pneumoniae (20.6%) and Escherichia coli (8.6%). Among the Gram-negative organisms, 12.8% were multidrug resistant (MDR). Eleven patients (20%) required admission to intensive care, and eight (14.8%) underwent invasive mechanical ventilation. Nine patients (16.3%) received inadequate empirical antibiotic therapy, of whom six (66.6%) died; eight of these nine patients had pneumonia caused by resistant microorganisms. The early (48 h) case-fatality rate was 24% and the overall (30 day) case-fatality rate was 46.2%. CONCLUSION:Bacteraemic pneumonia is a frequent complication among NCP and is mainly caused by P. aeruginosa and S. pneumoniae. The emergence of MDR organisms is of special concern. Despite the improvement in the management of cancerpatients, case-fatality rates of NCP with bacteraemic pneumonia remain high. Urgent assessment is needed to identify a better approach for the management and support of these patients.
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Authors: Adaia Albasanz-Puig; Xavier Durà-Miralles; Júlia Laporte-Amargós; Alberto Mussetti; Isabel Ruiz-Camps; Pedro Puerta-Alcalde; Edson Abdala; Chiara Oltolini; Murat Akova; José Miguel Montejo; Malgorzata Mikulska; Pilar Martín-Dávila; Fabián Herrera; Oriol Gasch; Lubos Drgona; Hugo Manuel Paz Morales; Anne-Sophie Brunel; Estefanía García; Burcu Isler; Winfried V Kern; Pilar Retamar-Gentil; José María Aguado; Milagros Montero; Souha S Kanj; Oguz R Sipahi; Sebnem Calik; Ignacio Márquez-Gómez; Jorge I Marin; Marisa Z R Gomes; Philipp Hemmati; Rafael Araos; Maddalena Peghin; José Luis Del Pozo; Lucrecia Yáñez; Robert Tilley; Adriana Manzur; Andres Novo; Natàlia Pallarès; Alba Bergas; Jordi Carratalà; Carlota Gudiol Journal: Microorganisms Date: 2022-03-29