Ortis Estacio1, Zoe Loh1, Amy Baker2, Geoff Chong2, Andrew Grigg1,2, Leonid Churilov3, Eliza A Hawkes2,4. 1. Department of Medicine, Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Melbourne, Victoria, Australia. 2. Department of Clinical Haematology and Medical Oncology, Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Melbourne, Victoria, Australia. 3. Statistics and Decision Analysis Academic Platform, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia. 4. Eastern Clinical Research Unit, Eastern Health Monash University Clinical School, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Routine chest X-ray (CXR) is recommended for neutropenic fever (NF) management however its role is relatively understudied in haematology patients. AIM: To investigate the utility of CXR in the diagnosis and management of patients with haematological conditions complicated by NF. METHODS: Retrospective, single-centre analysis of haematology patients admitted with NF between January 2011 and December 2015. Baseline demographics, treatment details and outcomes were collected from electronic patient records. CXR underwent independent radiology review. Primary endpoints were a proportion of NF episodes in which CXR detected a probable chest infection in the absence of respiratory symptoms/signs and/or resulted in a change in antibiotic management. RESULTS: Four hundred and thirty-five episodes were identified; CXR was performed in 75% of patients (65% within 2 days of NF). In 4 of 164 (2.4%) asymptomatic patients, CXR was consistent with infection, in contrast to 19 of 119 (16%) patients with clinical signs of respiratory infection. Only 3 of 283 (1.1%) CXR resulted in a change to antibiotics. CXR consistent with infection was not associated with increased mortality or increased admission length, although there was an association with intensive care unit admission (odds ratios: 7.61, 95% confidence interval: 2.04-28.31). CONCLUSION: In haematology patients with NF, CXR rarely detected chest infection or changed management in patients with no respiratory symptoms or signs. CXR in our institution is no longer part of routine assessment of NF in the absence of these features.
BACKGROUND: Routine chest X-ray (CXR) is recommended for neutropenic fever (NF) management however its role is relatively understudied in haematology patients. AIM: To investigate the utility of CXR in the diagnosis and management of patients with haematological conditions complicated by NF. METHODS: Retrospective, single-centre analysis of haematology patients admitted with NF between January 2011 and December 2015. Baseline demographics, treatment details and outcomes were collected from electronic patient records. CXR underwent independent radiology review. Primary endpoints were a proportion of NF episodes in which CXR detected a probable chest infection in the absence of respiratory symptoms/signs and/or resulted in a change in antibiotic management. RESULTS: Four hundred and thirty-five episodes were identified; CXR was performed in 75% of patients (65% within 2 days of NF). In 4 of 164 (2.4%) asymptomatic patients, CXR was consistent with infection, in contrast to 19 of 119 (16%) patients with clinical signs of respiratory infection. Only 3 of 283 (1.1%) CXR resulted in a change to antibiotics. CXR consistent with infection was not associated with increased mortality or increased admission length, although there was an association with intensive care unit admission (odds ratios: 7.61, 95% confidence interval: 2.04-28.31). CONCLUSION: In haematology patients with NF, CXR rarely detected chest infection or changed management in patients with no respiratory symptoms or signs. CXR in our institution is no longer part of routine assessment of NF in the absence of these features.
Authors: J R de la Court; A H W Bruns; A H E Roukens; I O Baas; K van Steeg; M L Toren-Wielema; M Tersmette; N M A Blijlevens; R A G Huis In 't Veld; T F W Wolfs; W J E Tissing; Y Kyuchukova; J Heijmans Journal: Infect Dis Ther Date: 2022-10-14
Authors: Jannik Stemler; Caroline Bruns; Sibylle C Mellinghoff; Nael Alakel; Hamdi Akan; Michelle Ananda-Rajah; Jutta Auberger; Peter Bojko; Pranatharthi H Chandrasekar; Methee Chayakulkeeree; José A Cozzi; Elizabeth A de Kort; Andreas H Groll; Christopher H Heath; Larissa Henze; Marcos Hernandez Jimenez; Souha S Kanj; Nina Khanna; Michael Koldehoff; Dong-Gun Lee; Alina Mager; Francesco Marchesi; Rodrigo Martino-Bufarull; Marcio Nucci; Jarmo Oksi; Livio Pagano; Bob Phillips; Juergen Prattes; Athina Pyrpasopoulou; Werner Rabitsch; Enrico Schalk; Martin Schmidt-Hieber; Neeraj Sidharthan; Pere Soler-Palacín; Anat Stern; Barbora Weinbergerová; Aline El Zakhem; Oliver A Cornely; Philipp Koehler Journal: J Fungi (Basel) Date: 2020-03-13