Gemma Martinez-Nadal1, Pedro Puerta-Alcalde2, Carlota Gudiol3,4, Celia Cardozo2, Adaia Albasanz-Puig3, Francesc Marco5,6, Júlia Laporte-Amargós3, Estela Moreno-García2, Eva Domingo-Doménech7, Mariana Chumbita2, José Antonio Martínez2,8, Alex Soriano2,8, Jordi Carratalà3,4, Carolina Garcia-Vidal2,8. 1. Internal Medicine Department, Hospital Clínic-Institut d'investigacions Biomèdiques August Pi i Sunyer. 2. Infectious Diseases Department, Hospital Clínic-Institut d'investigacions Biomèdiques August Pi i Sunyer. 3. Infectious Diseases Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat. 4. Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid. 5. Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic. 6. ISGlobal, Hospital Clínic-Universitat de Barcelona. 7. Hematology Department, Hospital Universitari de Bellvitge-Institut Català d'Oncologia. 8. University of Barcelona, Spain.
Abstract
BACKGROUND: We aimed to describe the current rates of inappropriate empirical antibiotic treatment (IEAT) in oncohematological patients with febrile neutropenia (FN) and its impact on mortality. METHODS: This was a multicenter prospective study of all episodes of bloodstream infection (BSI) in high-risk FN patients (2006-2017). Episodes receiving IEAT were compared with episodes receiving appropriate empirical therapy. Adherence to Infectious Diseases Society of America (IDSA) recommendations was evaluated. Multivariate analysis was performed to identify independent risk factors for mortality in Pseudomonas aeruginosa episodes. RESULTS: Of 1615 episodes, including Escherichia coli (24%), coagulase-negative staphylococci (21%), and P. aeruginosa (16%), 394 (24%) received IEAT despite IDSA recommendations being followed in 87% of cases. Patients with multidrug-resistant gram-negative bacilli (MDR-GNB), accounting for 221 (14%) of all isolates, were more likely to receive IEAT (39% vs 7%, P < .001). Overall mortality was higher in patients with GNB BSI who received IEAT (36% vs 24%, P = .004); when considering individual microorganisms, only patients with infection caused by P. aeruginosa experienced a significant increase in mortality when receiving IEAT (48% vs 31%, P = .027). Independent risk factors for mortality in PA BSI (odds ratio [95% confidence interval] were IEAT (2.41 [1.19-4.91]), shock at onset (4.62 [2.49-8.56]), and pneumonia (3.01 [1.55-5.83]). CONCLUSIONS: IEAT is frequent in high-risk patients with FN and BSI, despite high adherence to guidelines. This inappropriate treatment primarily impacts patients with P. aeruginosa-related BSI mortality and in turn is the only modifiable factor to improve outcomes.
BACKGROUND: We aimed to describe the current rates of inappropriate empirical antibiotic treatment (IEAT) in oncohematological patients with febrile neutropenia (FN) and its impact on mortality. METHODS: This was a multicenter prospective study of all episodes of bloodstream infection (BSI) in high-risk FN patients (2006-2017). Episodes receiving IEAT were compared with episodes receiving appropriate empirical therapy. Adherence to Infectious Diseases Society of America (IDSA) recommendations was evaluated. Multivariate analysis was performed to identify independent risk factors for mortality in Pseudomonas aeruginosa episodes. RESULTS: Of 1615 episodes, including Escherichia coli (24%), coagulase-negative staphylococci (21%), and P. aeruginosa (16%), 394 (24%) received IEAT despite IDSA recommendations being followed in 87% of cases. Patients with multidrug-resistant gram-negative bacilli (MDR-GNB), accounting for 221 (14%) of all isolates, were more likely to receive IEAT (39% vs 7%, P < .001). Overall mortality was higher in patients with GNB BSI who received IEAT (36% vs 24%, P = .004); when considering individual microorganisms, only patients with infection caused by P. aeruginosa experienced a significant increase in mortality when receiving IEAT (48% vs 31%, P = .027). Independent risk factors for mortality in PA BSI (odds ratio [95% confidence interval] were IEAT (2.41 [1.19-4.91]), shock at onset (4.62 [2.49-8.56]), and pneumonia (3.01 [1.55-5.83]). CONCLUSIONS:IEAT is frequent in high-risk patients with FN and BSI, despite high adherence to guidelines. This inappropriate treatment primarily impacts patients with P. aeruginosa-related BSI mortality and in turn is the only modifiable factor to improve outcomes.
Authors: Joyce Ji; Jeff Klaus; Jason P Burnham; Andrew Michelson; Colleen A McEvoy; Marin H Kollef; Patrick G Lyons Journal: Chest Date: 2020-06-17 Impact factor: 9.410
Authors: A Albasanz-Puig; C Gudiol; P Puerta-Alcalde; C M Ayaz; M Machado; F Herrera; P Martín-Dávila; J Laporte-Amargós; C Cardozo; M Akova; A Álvarez-Uría; D Torres; J Fortún; C García-Vidal; P Muñoz; A Bergas; H Pomares; S Mercadal; X Durà-Miralles; E García-Lerma; N Pallarès; J Carratalà Journal: Antimicrob Agents Chemother Date: 2021-07-16 Impact factor: 5.191
Authors: José M Miró; Carolina Garcia-Vidal; Pedro Puerta-Alcalde; Juan Ambrosioni; Mariana Chumbita; Marta Hernández-Meneses; Nicole Garcia-Pouton; Celia Cardozo; Estela Moreno-García; Francesc Marco; Josep Mensa; Montserrat Rovira; Jordi Esteve; Jose A Martínez; Felipe García; Josep Mallolas; Alex Soriano Journal: Infect Dis Ther Date: 2021-04-11