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Zheng H, Luo Z, Yi Y, Liu K, Huo Z, You Y, Li H, Tang M. Assessment value of interleukin-6, procalcitonin, and C-reactive protein early kinetics for initial antibiotic efficacy in patients with febrile neutropenia: A prospective study. Cancer Med 2024; 13:e7307. [PMID: 38967137 PMCID: PMC11224913 DOI: 10.1002/cam4.7307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND This study aims to investigate the early kinetics of interleukin 6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) on initial antibiotic efficacy in hematological disorder patients with febrile neutropenia (FN). METHODS A total of 40 patients with 43 episodes of FN were enrolled and divided into initial antibiotic effective group (IAE group, n = 24) and initial antibiotic ineffective group (IAI group, n = 19). The levels of IL-6, PCT, and CRP before antibacterial treatment (T0), and 12 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4) post-antibacterial treatment were determined, respectively. Furthermore, the receiver operating characteristic curve (ROC) analysis was performed to evaluate the clinical value of indicators. RESULTS In IAE group, the IL-6 levels gradually decreased from T0 to T4, and the CRP levels significantly decreased at 48 to 72 h, whereas both IL-6 and CRP remained at high levels in the IAI group. The PCT levels in both groups increased at the early stage of anti-infection (T1-T2) and reached to peak at T1-T2 in effective group. ROC curve analysis identified IL-6 as a predictive biomarker for initial antibiotic efficacy at 12, 48, and 72 h after treatment, with the AUC of 0.698, 0.744, and 0.821, respectively. In addition, CRP demonstrated predictive ability of initial antibiotics against infection at 24, 48, and 72 h after therapy, with the AUC of 0.724, 0.741, and 0.797, respectively. ROC curve analysis of percentage changes demonstrated that IL-6 percentage change showed predictive ability of antibiotic efficacy at the early stage, and both the IL-6 and CRP percentage changes showed the predictive ability of antibiotic efficacy 48 or 72 h after antibiotics therapy. CONCLUSION This study confirmed IL-6 and CRP levels, and the percentage change in IL-6 as the biomarkers for initial antibiotic efficacy prediction in hematological disorder patients with FN.
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Affiliation(s)
- Haifeng Zheng
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Zimian Luo
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Yafei Yi
- Department of HematologyChangsha Central HospitalChangshaChina
| | - Kang Liu
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Zhongjun Huo
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Yaqin You
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Hujiao Li
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Min Tang
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
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Fan M, Zhang W, Zhou Y, Li M, Wang D, Qiu K, Li M, Guo H, Yan L. A retrospective study on the analysis of influencing factors of neutropenia in endometrial cancer with adjuvant chemoradiotherapy. Radiat Oncol 2024; 19:76. [PMID: 38890652 PMCID: PMC11186186 DOI: 10.1186/s13014-024-02469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to investigate the factors influencing the occurrence of neutropenia in patients with endometrial cancer (EC) following adjuvant chemoradiotherapy (CRT). METHODS Retrospective analysis of EC patients who underwent adjuvant CRT from January 2012 to June 2023 in the Department of Gynecology and Oncology of the First Affiliated Hospital of Shandong First Medical University. Neutropenia was defined as an Absolute Neutrophil Count (ANC) of peripheral blood neutrophils below 2 × 109/L. Factors affecting neutropenia in EC patients treated with CRT using Generalized Estimating Equation (GEE), and Logistic regression was used to further analyze the effect of adding radiotherapy to different chemotherapy cycles on neutropenia, so that patients receive optimal adjuvant CRT while the risk of neutropenia is appropriately controlled. RESULTS A total of 144 patients met the inclusion criteria. They underwent 330 cycles of adjuvant chemotherapy, of whom 96 (66.7%) developed neutropenia, which occurred 140 times. The results of one-way GEE analysis showed that before CRT, White Blood Cell (WBC) (OR = 0.827; 95%CI, 0.701-0.976), ANC (OR = 0.749; 95%CI, 0.586-0.957), Absolute Monocyte Count (AMC) (OR = 0.047; 95%CI, 0.008-0.283), Blood Urea Nitrogen (BUN) (OR = 0.857; 95%CI, 0.741-0.991), platinum and docetaxel (platinum/docetaxel) dosing regimen (OR = 2.284; 95%CI, 1.130-4.618) were associated with neutropenia with adjuvant CRT for EC (p < 0.05), results of multifactorial GEE analysis showed that before adjuvant CRT ANC (OR = 0.552; 95%CI, 0.973-2.231), AMC (OR = 0.047; 95%CI, 0.004-0.052), platinum/docetaxel (OR = 2.437; 95%CI, 1.087-5.464) were an independent influence on neutropenia in adjuvant CRT for EC (p < 0.05). Multifactorial Logistic regression shows addition of radiotherapy to the first cycle of chemotherapy (OR = 4.413; 95%CI, 1.238-18.891) was an independent influence of neutropenia (p < 0.05). CONCLUSIONS Patients with low pre-CRT ANC and AMC, platinum/docetaxel dosing regimens need to be closely monitored during each cycle of CRT. Also, the concurrent addition of radiotherapy should be avoided during the first cycle of chemotherapy.
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Affiliation(s)
- Mengsi Fan
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Weiwei Zhang
- Department of Gynecology, Tengzhou Maternal and Child Health Hospital, Tengzhou, China
| | - Yuying Zhou
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Data Open innovative Application Laboratory, Jinan, China
| | - Dongyue Wang
- School of Clinical Medicine, Shandong First Medical University, Jinan, China
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Kexin Qiu
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Mengzhen Li
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Haoran Guo
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Li Yan
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China.
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Choi H, Choi MH, Kim D, Lee KH, Jeong SH. Shifting trends in bloodstream infection-causing microorganisms and their clinical impact in patients with haematologic malignancies in South Korea: A propensity score-matched study. Int J Antimicrob Agents 2024; 64:107212. [PMID: 38795932 DOI: 10.1016/j.ijantimicag.2024.107212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/20/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND This study aimed to identify recent trends in the epidemiology of bloodstream infection (BSI)-causing microorganisms among patients with haematologic malignancies (HMs) between 2011 and 2021, and to determine their impact on patient outcomes. METHODS This retrospective study included 6792 patients with HMs, of whom 1308 (19.3%) developed BSI within 1 y of diagnosis. The incidence of BSI-causing microorganisms was determined, and a propensity score-matched study was performed to identify risk factors for 28-d all-cause mortality in patients with HM. RESULTS A total of 6792 patients with HMs were enrolled. The cumulative incidence of BSI and neutropenia was significantly higher in the acute myeloid leukaemia and acute lymphoblastic leukaemia groups compared to other groups, and neutropenia and type of HMs were risk factors for the development of BSI. The annual incidence of coagulase-negative staphylococci (CoNS)-BSI decreased significantly (P < 0.001), whereas Klebsiella pneumoniae-BSI increased (P = 0.01). Carbapenem nonsusceptibility rates in K. pneumoniae isolates increased from 0.0% to 76.5% (P < 0.001). BSI caused by K. pneumoniae (adjusted odds ratio 2.17; 95% confidence interval 1.12-4.21) was associated with higher 28-d all-cause mortality compared to that caused by CoNS (adjusted odds ratio 0.86; 95% confidence interval 0.48-1.55). CONCLUSION The pathogenic spectrum of BSI-causing bacteria in patients with HMs gradually shifted from Gram-positive to Gram-negative, especially from CoNS to K. pneumoniae. Considering that K. pneumoniae-BSI had a significantly higher 28-d mortality rate than CoNS-BSI, this evolving trend could adversely impact the clinical outcomes of patients with HMs.
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Affiliation(s)
- Heekang Choi
- Department of Laboratory Medicine, Gangnam Severance Hospital, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Hyuk Choi
- Department of Laboratory Medicine, Gangnam Severance Hospital, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
| | - Dokyun Kim
- Department of Laboratory Medicine, Gangnam Severance Hospital, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Gangnam Severance Hospital, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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Crooker KG, Stedman ER, Hitt JR, Tompkins BJ, Repp AB. Causes and outcomes of non-chemotherapy induced neutropenic fever in hospitalized adults: An observational study. Medicine (Baltimore) 2024; 103:e38060. [PMID: 38701281 PMCID: PMC11062702 DOI: 10.1097/md.0000000000038060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Neutropenic fever in adults undergoing chemotherapy for cancer treatment is a medical emergency and has been the focus of numerous studies. However, there is a paucity of data about non-chemotherapy induced neutropenic fever (non-CINF). We retrospectively reviewed 383 adults with neutropenic fever hospitalized at one academic medical center between October 2015 and September 2020 to characterize the frequency, causes, and outcomes of non-CINF. Twenty-six percent of cases of neutropenic fever were non-chemotherapy induced. Among these, the major causes of neutropenia were hematologic malignancy, infection, and rheumatologic disease, and the major causes of fever were infections. Patients with non-CINF had a higher 30-day mortality than those with chemotherapy induced neutropenic fever (25% vs 13%, P = .01). Non-CINF constituted > 25% of neutropenic fever events in hospitalized adults and was associated with a high mortality rate.
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Affiliation(s)
- Kyle G. Crooker
- Department of Medicine, University of Vermont Medical Center, Burlington, VT
| | - Eleanor R. Stedman
- Department of Medicine, University of Vermont Medical Center, Burlington, VT
| | - Juvena R. Hitt
- Department of Medicine, The Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Bradley J. Tompkins
- Department of Medicine, The Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Allen B. Repp
- Department of Medicine, University of Vermont Medical Center, Burlington, VT
- Department of Medicine, The Larner College of Medicine at the University of Vermont, Burlington, VT
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Wang X, Zhang H, Zhang N, Zhang S, Shuai Y, Miao X, Liu Y, Qiu L, Ren S, Lai S, Han Y, Yao H, Zhang X, Fan F, Sun H, Yi H. Application value of metagenomic next-generation sequencing in hematological patients with high-risk febrile neutropenia. Front Cell Infect Microbiol 2024; 14:1366908. [PMID: 38725449 PMCID: PMC11079123 DOI: 10.3389/fcimb.2024.1366908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Background Metagenomic next-generation sequencing (mNGS) is a novel non-invasive and comprehensive technique for etiological diagnosis of infectious diseases. However, its practical significance has been seldom reported in the context of hematological patients with high-risk febrile neutropenia, a unique patient group characterized by neutropenia and compromised immune responses. Methods This retrospective study evaluated the results of plasma cfDNA sequencing in 164 hematological patients with high-risk febrile neutropenia. We assessed the diagnostic efficacy and clinical impact of mNGS, comparing it with conventional microbiological tests. Results mNGS identified 68 different pathogens in 111 patients, whereas conventional methods detected only 17 pathogen types in 36 patients. mNGS exhibited a significantly higher positive detection rate than conventional methods (67.7% vs. 22.0%, P < 0.001). This improvement was consistent across bacterial (30.5% vs. 9.1%), fungal (19.5% vs. 4.3%), and viral (37.2% vs. 9.1%) infections (P < 0.001 for all comparisons). The anti-infective treatment strategies were adjusted for 51.2% (84/164) of the patients based on the mNGS results. Conclusions mNGS of plasma cfDNA offers substantial promise for the early detection of pathogens and the timely optimization of anti-infective therapies in hematological patients with high-risk febrile neutropenia.
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Affiliation(s)
- Xiao Wang
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Huiye Zhang
- School of Pharmacy, Chengdu Medical College, Chengdu, China
- Department of Pharmacy, Chengdu Eighth People’s Hospital, Chengdu, China
| | - Nan Zhang
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Shan Zhang
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Yanrong Shuai
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xiaojuan Miao
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Yilan Liu
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Ling Qiu
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Shihui Ren
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Sihan Lai
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Ying Han
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Hao Yao
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xupai Zhang
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Fangyi Fan
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Haoping Sun
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
| | - Hai Yi
- Department of Hematology, The General Hospital of Western Theater Command, Chengdu, China
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Babakhanlou R, Ravandi-Kashani F, Hita AG, Kontoyiannis DP. Anorectal Infections in Neutropenic Leukemia Patients: A Common Clinical Challenge. J Hematol 2024; 13:1-11. [PMID: 38644983 PMCID: PMC11027774 DOI: 10.14740/jh1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/29/2024] [Indexed: 04/23/2024] Open
Abstract
Anorectal infections in neutropenic leukemia patients are a significant and potentially life-threatening complication. The pathogenesis of this condition is not entirely understood and believed to be multifactorial, including mucosal injury as a result of cytotoxic drugs, profound neutropenia and impaired host defense. Establishing an early diagnosis is key and often made clinically on the basis of signs and symptoms, but also from imaging studies demonstrating perianal inflammation or fluid collection. The management of anorectal infections in neutropenic leukemia patients is not straightforward, as there are no well-conducted studies on this entity. This review seeks to provide a framework into the pathophysiology and clinical presentation of anorectal infections in neutropenic leukemia patients, propose a diagnostic approach and to discuss controversies in the management of this condition.
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Affiliation(s)
- Rodrick Babakhanlou
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Farhad Ravandi-Kashani
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Angel G. Hita
- Department of Emergency Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dimitrios P. Kontoyiannis
- Division of Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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Ghaffari K, Falahati V, Motallebirad T, Safarabadi M, Tashakor AH, Azadi D. Microbiological and Molecular Study of Paranasal Sinus Infections of Children with Malignancy and Unknown Origin Fever in Markazi Province, Iran. CURRENT THERAPEUTIC RESEARCH 2024; 100:100745. [PMID: 38617893 PMCID: PMC11015527 DOI: 10.1016/j.curtheres.2024.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/13/2024] [Indexed: 04/16/2024]
Abstract
Background Children with malignancies are vulnerable to various infections, including sinus infections. Sinusitis is primarily caused by bacterial infections, followed by fungal infections. Due to this, evaluating the occurrence, diversity, and antibiotic susceptibility patterns of bacterial species that cause paranasal sinus infections in children with malignancy and unexplained fever is important. Objective To investigate the bacterial species accountable for sinusitis in children with malignancy and unexplained fever, and determine their susceptibility to antibiotics. Methods The study involved collecting 90 sinus samples from children aged 5 to 15 years with malignancy in Arak City, Iran. The isolates were identified using a combination of phenotypic, biochemical, and molecular techniques, including specific polymerase chain reaction and 16S ribosomal RNA gene sequencing. Drug susceptibility testing was performed following the Clinical & Laboratory Standards Institute 2021 guidelines. Results A total of 36 isolates (40%) were obtained, including 4 isolates of Nocardia (11.12%), 4 isolates of Escherichia coli (11.12%), 3 isolates of Klebsiella pneumoniae (8.33%), 5 isolates of Pseudomonas aeruginosa (13.88%), 3 isolates of Acinetobacter baumannii (8.33%), 4 isolates of Staphylococcus aureus (11.12%), 3 isolates of Staphylococcus epidermidis (8.33%), 5 isolates of Streptococcus agalactiae (13.88%), 2 isolates of Streptococcus pneumoniae (5.55%), and 3 isolates of Enterococcus faecium (8.33%). The isolates showed the most sensitivity to imipenem and trimethoprim-sulfamethoxazole and the least sensitivity to erythromycin and tetracycline. Conclusions The findings of the study indicate that sinusitis can contribute to fever of unknown origin in patients with cancer. Therefore, it is recommended to use a combination of molecular and phenotypic methods for accurate identification of isolates. This approach can provide more reliable and precise results, leading to better diagnosis and treatment of sinusitis infections in children with malignancy.
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Affiliation(s)
- Kazem Ghaffari
- Department of Basic Sciences, Khomein University of Medical Sciences, Khomein, Iran
- Student Research Comittee, Khomein University Of Medical Sciences, Khomein, Iran
| | - Vahid Falahati
- Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
| | - Tahereh Motallebirad
- Department of Basic Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Mahdi Safarabadi
- Department of Nursing, Khomein University of Medical Sciences, Khomein, Iran
| | - Amir Hossein Tashakor
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Azadi
- Department of Basic Sciences, Khomein University of Medical Sciences, Khomein, Iran
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Shmuely H, Monely L, Shvidel L. All-Cause Mortality and Its Predictors in Haemato-Oncology Patients with Febrile Neutropenia. J Clin Med 2023; 12:5635. [PMID: 37685702 PMCID: PMC10489066 DOI: 10.3390/jcm12175635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Febrile neutropenia (FN) is one of the most important life-threatening complications in haemato-oncology. Our objective was to report all-cause mortality rates in patients ill with a hematological malignancy (HM) hospitalized with a first FN episode and to identify predictors for mortality. We conducted a historical retrospective cohort study of consecutive patients with an HM, >18 years of age, admitted between January 2012 and August 2018 for a first episode of FN. Data on all-cause mortality 12 months after admission for FN were obtained. The Kaplan-Meier curve was used to describe mortality during the follow-up period. Univariate and multivariable analyses identified predictors for 1,3 and 12-month mortality. One hundred and fifty-eight patients (mean age 69.5, 49.4% males) were included. Overall, 54 patients died (15.8%, 25.9%, and 34.1% died after 1, 3, and 12 months, respectively). Lower serum albumin, higher serum gamma-glutamyl transferase (GGT), lower estimated glomerular filtration rate (eGFR), older age, higher temperature, and lower absolute lymphocyte count at admission were independent predictors of all-cause mortality after 12 months. Further studies are needed to confirm our results and identify therapeutic strategies to improve survival.
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Affiliation(s)
- Haim Shmuely
- Department of Internal Medicine D, Kaplan Medical Center, Rehovot 7612001, Israel;
- Faculty of Medicine, Hebrew University, Jerusalem 9112001, Israel;
| | - Lea Monely
- Department of Internal Medicine D, Kaplan Medical Center, Rehovot 7612001, Israel;
- Faculty of Medicine, Hebrew University, Jerusalem 9112001, Israel;
| | - Lev Shvidel
- Faculty of Medicine, Hebrew University, Jerusalem 9112001, Israel;
- Institute of Hematology, Kaplan Medical Center, Rehovot 7612001, Israel
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De Oliveira Brandao C, Lewis S, Sandschafer D, Crawford J. Two decades of pegfilgrastim: what have we learned? Where do we go from here? Curr Med Res Opin 2023; 39:707-718. [PMID: 36976784 DOI: 10.1080/03007995.2023.2196197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Chemotherapy-induced febrile neutropenia (FN) is a medical emergency that may occur in patients with malignancies receiving myelosuppressive chemotherapy. FN requires early therapeutic intervention since it is associated with increased hospitalizations and high mortality risk of 5%-20%. FN-related hospitalizations are higher in patients with myeloid malignancies than in those with solid tumors due to the myelotoxicity of chemotherapy regimens and the compromised bone marrow function. FN increases the burden of cancer by causing chemotherapy dose reductions and delays. The administration of the first granulocyte colony-stimulating factor (G-CSF), filgrastim, reduced the incidence and duration of FN in patients undergoing chemotherapy. Filgrastim later evolved into pegfilgrastim, which has a longer half-life than filgrastim and was associated with a lower rate of severe neutropenia, chemotherapy dose reduction, and treatment delay. Nine million patients have received pegfilgrastim since its approval in early 2002. The pegfilgrastim on-body injector (OBI) is an innovative device facilitating the time-released auto-injection of pegfilgrastim approximately 27 hours after chemotherapy, as clinically recommended for the prevention of FN, thus eliminating the need for a next-day hospital visit. Since its introduction in 2015, one million patients with cancer have received pegfilgrastim using the OBI. Subsequently, the device has been approved in the United States (US), European Union, Latin America, and Japan, with studies and a postmarketing commitment demonstrating device reliability. A recent prospective observational study conducted in the US demonstrated that the OBI substantially improved the adherence to and compliance with clinically recommended pegfilgrastim therapy; patients receiving pegfilgrastim via the OBI experienced a lower incidence of FN than those receiving alternatives for FN prophylaxis. This review discusses the evolution of G-CSFs leading to the development of the OBI, current recommendations for G-CSF prophylaxis in the clinic, continued evidence supporting next-day pegfilgrastim administration, and improvements in patient care made possible with the OBI.
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Affiliation(s)
| | - Sandra Lewis
- Global Research & Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Jeffrey Crawford
- Medical Oncology, Division of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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The Prognostic Utility of Lymphocyte-Based Measures and Ratios in Chemotherapy-Induced Febrile Neutropenia Patients following Granulocyte Colony-Stimulating Factor Therapy. Medicina (B Aires) 2022; 58:medicina58111508. [DOI: 10.3390/medicina58111508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives: Chemotherapy-induced febrile neutropenia is the most widespread oncologic emergency with high morbidity and mortality rates. Herein we present a retrospective risk factor identification study to evaluate the prognostic role of lymphocyte-based measures and ratios in a cohort of chemotherapy-induced febrile neutropenia patients following granulocyte colony-stimulating factor (G-CSF) therapy. Materials and Methods: The electronic medical records at our center were utilized to identify patients with a first attack of chemotherapy-induced febrile neutropenia and were treated accordingly with G-CSF between January 2010 to December 2020. Patients’ demographics and disease characteristics along with laboratory tests data were extracted. Prognosis-related indicators were the absolute neutrophil count (ANC) at admission and the following 6 days besides the length of stay and mortality rate. Results: A total of 80 patients were enrolled, which were divided according to the absolute lymphocyte count at admission into two groups, the first includes lymphopenia patients (n = 55) and the other is the non-lymphopenia group (n = 25) with a cutoff point of 700 lymphocytes/μL. Demographics and baseline characteristics were generally insignificant among the two groups but the white blood cell count was higher in the non-lymphopenia group. ANC, neutrophils percentage and ANC difference in reference to admission among the two study groups were totally insignificant. The same insignificant pattern was observed in the length of stay and the mortality rate. Univariate analysis utilizing the ANC difference compared to the admission day as the dependent variable, revealed no predictability role in the first three days of follow up for any of the variables included. However, during the fourth day of follow up, both WBC (OR = 0.261; 95% CI: 0.075, 0.908; p = 0.035) and lymphocyte percentage (OR = 1.074; 95% CI: 1.012, 1.141; p = 0.019) were marginally significant, in which increasing WBC was associated with a reduction in the likelihood of ANC count increase, compared to the lymphocyte percentage which exhibited an increase in the likelihood. In comparison, sequential ANC difference models demonstrated lymphocyte percentage (OR = 0.961; 95% CI: 0.932, 0.991; p = 0.011) and monocyte-to-lymphocyte ratio (OR = 7.436; 95% CI: 1.024, 54.020; p = 0.047) reduction and increment in the enhancement of ANC levels, respectively. The fifth day had WBC (OR = 0.790; 95% CI: 0.675, 0.925; p = 0.003) to be significantly decreasing the likelihood of ANC increment. Conclusions: we were unable to determine any concrete prognostic role of lymphocyte-related measures and ratios. It is plausible that several limitations could have influenced the results obtained, but as far as our analysis is concerned ALC role as a predictive factor for ANC changes remains questionable.
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Adekunle MO, Davidson A, Hendricks M. Risk factors and predictors of adverse outcomes of in paediatric febrile neutropenia. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.4102/sajo.v6i0.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Janjusevic A, Cirkovic I, Minic R, Stevanovic G, Soldatovic I, Mihaljevic B, Vidovic A, Markovic Denic L. Predictors of Vancomycin-Resistant Enterococcus spp. Intestinal Carriage among High-Risk Patients in University Hospitals in Serbia. Antibiotics (Basel) 2022; 11:antibiotics11091228. [PMID: 36140006 PMCID: PMC9495008 DOI: 10.3390/antibiotics11091228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
The predictors of intestinal carriage of vancomycin-resistant Enterococcus spp. (VRE) among high-risk patients in the counties of the Southeast Europe Region are insufficiently investigated, yet they could be of key importance in infection control. The aim of the study was to identify risk factors associated with fecal VRE colonization among high-risk inpatients in university hospitals in Serbia. The study comprised 268 inpatients from three university hospitals. Data on patient demographics and clinical characteristics, length of hospital stay, therapy, and procedures were obtained from medical records. Chi-squared tests and univariate and multivariate logistic regressions were performed. Compared to the hemodialysis departments, stay in the geriatric departments, ICUs, and haemato-oncology departments increased the risk for VRE colonization 7.6, 5.4, and 5.5 times, respectively. Compared to inpatients who were hospitalized 48 h before stool sampling for VRE isolation, inpatients hospitalized 3–7, 8–15, and longer than 16 days before sampling had 5.0-, 4.7-, and 6.6-fold higher risk for VRE colonization, respectively. The use of cephalosporins and fluoroquinolones increased the risk for VRE colonization by 2.2 and 1.9 times, respectively. The age ≥ 65 years increased the risk for VRE colonization 2.3 times. In comparison to the University Clinical Centre of Serbia, the hospital stays at Zemun and Zvezdara University Medical Centres were identified as a protector factors. The obtained results could be valuable in predicting the fecal VRE colonization status at patient admission and consequent implementation of infection control measures targeting at-risk inpatients where VRE screening is not routinely performed.
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Affiliation(s)
- Ana Janjusevic
- Institute of Virology, Vaccines and Sera “Torlak”, 11152 Belgrade, Serbia
- Correspondence:
| | - Ivana Cirkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Microbiology and Immunology, 11000 Belgrade, Serbia
| | - Rajna Minic
- Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11129 Belgrade, Serbia
| | - Goran Stevanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical Statistics, 11000 Belgrade, Serbia
| | - Biljana Mihaljevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Hematology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ana Vidovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Hematology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ljiljana Markovic Denic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Epidemiology, 11129 Belgrade, Serbia
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13
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Amano E, Tanaka R, Ono H, Tatsuta R, Hashimoto T, Hiramatsu K, Itoh H. Association of Vancomycin Trough Concentration and Clearance With Febrile Neutropenia in Pediatric Patients. Ther Drug Monit 2022; 44:543-551. [PMID: 35821590 DOI: 10.1097/ftd.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Febrile neutropenia promotes renal drug excretion. Adult and pediatric patients with febrile neutropenia exhibit a lower vancomycin concentration/dose (relative to bodyweight) ratio than those with other infections. In pediatric patients, renal function relative to bodyweight varies depending on age, and vancomycin clearance is age dependent. This study aimed to analyze the effects of febrile neutropenia on the pharmacokinetics of vancomycin in age-stratified pediatric patients. METHODS This retrospective, single-center, observational cohort study analyzed 112 hospitalized pediatric patients who met the selection criteria and intravenously received vancomycin at the Department of Pediatrics of the Oita University Hospital between April 2011 and October 2019. RESULTS The febrile neutropenia (n = 46) cohort exhibited a significantly higher estimated glomerular filtration rate than the nonfebrile neutropenia (n = 66) cohort. Compared with those in the nonfebrile neutropenia cohort, the daily vancomycin dose relative to bodyweight and vancomycin clearance were significantly higher, and the vancomycin trough concentration and vancomycin concentration/dose ratio were significantly lower in the febrile neutropenia cohort. In the age groups of 1-6 and 7-12 years, compared with those in the nonfebrile neutropenia cohort, the vancomycin concentration/dose ratio was significantly lower, and vancomycin clearance was significantly higher in the febrile neutropenia cohort. Univariate and multivariate analyses identified febrile neutropenia as the independent factor influencing vancomycin concentration/dose ratio and clearance only in pediatric patients aged 1-6 years. CONCLUSIONS Increased initial dosage and therapeutic drug monitoring-guided dose optimization are critical for the therapeutic efficacy of vancomycin in pediatric patients with febrile neutropenia, especially in those aged 1-6 years.
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Affiliation(s)
- Erino Amano
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan; and
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan; and
| | - Hiroyuki Ono
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan; and
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan; and
| | - Takehiro Hashimoto
- Department of Respiratory Medicine and Infectious Diseases, Oita University, Faculty of Medicine, Yufu, Oita, Japan
| | - Kazufumi Hiramatsu
- Department of Respiratory Medicine and Infectious Diseases, Oita University, Faculty of Medicine, Yufu, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan; and
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14
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Zhang M, Wang Z, Wang J, Lv H, Xiao X, Lu W, Jin X, Meng J, Pu Y, Zhao M. The Value of Metagenomic Next-Generation Sequencing in Hematological Malignancy Patients with Febrile Neutropenia After Empiric Antibiotic Treatment Failure. Infect Drug Resist 2022; 15:3549-3559. [PMID: 35837537 PMCID: PMC9273631 DOI: 10.2147/idr.s364525] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background It was crucial to use empirical antibiotics in febrile neutropenia (FN) patients. However, most patients still died from infection due to poor efficacy. Metagenomic next-generation sequencing (mNGS) is a rapid microbiological diagnostic method. The value of mNGS in patients with FN remains to be studied, especially after empiric antibiotic treatment. Methods We retrospectively analyzed the differences between mNGS and the traditional methods in 192 patients with hematological malignancies who have received empiric antibiotic treatment. Samples were collected when patient had chills or half an hour before peak body temperature. And we compared the differences between FN and non-FN patients, mainly including types of pathogens and the diagnostic value of different pathogens. Results Despite receiving empirical treatment, the pathogen detection rate of mNGS was significantly higher than the traditional method (80.21% vs 25.00%, P<0.001). And it has obvious advantages in detecting mixed pathogens infection (80.21% vs 4.17%, P<0.001). Then, we found that mNGS saw more pathogens in the FN than in the non-FN group, especially fungus. 21/33 (63.63%) of FN patients was diagnosed with fungal infections. The fungal detection rate in FN was significantly higher than non-FN group (32.35% vs 12.22%, P=0.001). Besides, the sensitivity of mNGS was higher than the traditional methods in both FN and non-FN group (P<0.001), but no significant difference in specificity (P>0.05). In the FN group, empiric antibiotic treatment of 46/102 (45.10%) patients did not treat all the pathogens detected by mNGS. After adjusting the antimicrobial regimen according to the results of mNGS, the effective rate at 72 hours and 7 days was 22/46 (47.83%) and 24/102 (52.17%), respectively. Conclusion mNGS had a significant impact on the diagnosis of infection and the second-line antimicrobial therapy in FN. mNGS plays a more important role in FN patients, especially in the diagnosis of fungal infections. Purpose Firstly, we compared the difference between mNGS and the traditional methods in the diagnosis of infection. Secondly, we assessed the value of mNGS in FN patients by comparing it with non-FN patients, including types of pathogens and the diagnostic value of different pathogens. In order to show that mNGS plays a more important role in FN.
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Affiliation(s)
- Meng Zhang
- First Central Clinical College, Tianjin Medical University, Tianjin, 300192, People's Republic of China.,Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Zhao Wang
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Jiaxi Wang
- First Central Clinical College, Tianjin Medical University, Tianjin, 300192, People's Republic of China
| | - Hairong Lv
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Xia Xiao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Wenyi Lu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Xin Jin
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Juanxia Meng
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Yedi Pu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - MingFeng Zhao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
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15
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Brown CR, Samade R, Lynch D, Mickley J, Larkin KT, Speeckaert AL. What is the role of leukopenia in the assessment of septic arthritis? J Orthop 2022; 32:13-17. [DOI: 10.1016/j.jor.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
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16
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Wanitpongpun C, Teawtrakul N, Lanamtieng T, Chansung K, Sirijeerachai C, Amampai W, Sawanyawisuth K. Clinical factors predictive of recurrent febrile neutropenia in adult patients with acute leukemia. Leuk Res Rep 2022; 17:100296. [PMID: 35251930 PMCID: PMC8889242 DOI: 10.1016/j.lrr.2022.100296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Febrile neutropenia (FN) is considered an oncologic emergency in acute leukemia. There were 250 FN events in 124 hospitalized patients with hematologic malignancy. These data imply that two FN events may occur per patient, yet data on the prevalence, risk factors, and outcomes of recurrent FN in adult patients with leukemia are limited. A retrospective cohort study was conducted that enrolled adult patients diagnosed with acute leukemia who developed FN. The eligible patients were categorized as with or without recurrent FN. A stepwise, multivariate logistic regression analysis was performed to identify predictors of recurrent FN. A total of 203 patients met the study criteria; of these, 46 (22.66%) had recurrent FN, and this group had a median of three recurrent FN emergencies. After adjusted, three independent factors remained in the final model including ALL, FN at admission, and treatment with idarubicin (3 days) and cytarabine (7 days). The three factors were positively associated with recurrent FN with adjusted odds ratios of 6.253, 4.068, and 10.757, respectively. No significant differences were found between the two groups in terms of other sources of infection, other pathogens, ICU stay, hospital stay, and mortality. ALL and FN at admission and treatment with idarubicin (3 days) and cytarabine (7 days) were associated with recurrent FN in acute leukemia patients with FN. Clinical outcomes for patients with or without recurrent FN were mostly comparable; however, due to its small sample size, further studies are required to confirm the results of this study.
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17
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Arıkan K, Karadağ-Oncel E, Aytac S, Cengiz AB, Duygu Cetinkaya F, Kara A, Ceyhan M. The use of serum endothelial adhesion molecules in pediatric patients with leukemia with febrile neutropenia to predict bacteremia. Cytokine 2021; 148:155692. [PMID: 34500368 DOI: 10.1016/j.cyto.2021.155692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/01/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Febrile neutropenia (FN) represents a life-threatening complication in hematological malignancies. We aimed to analyze the utility of soluble vascular cell adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule 1 (sICAM-1), vascular endothelial growth factor (VEGF) levels compared with C-reactive protein (CRP) and procalcitonin (PCT) during febrile neutropenia episodes of pediatric patients with leukemia. METHODS Two plasma samples, on day 0 (initial of episode) and day 3 (48-72 h after episode), for VCAM-1, ICAM-1 and VEGF, CRP and PCT were prospectively collected concomitantly during each febrile neutropenic episode between December 2016 and December 2017. The primary outcome was bacteremia and the secondary outcome was intensive care unit (ICU) admission. RESULTS Twenty-two (28.6%) acute lymphoblastic lymphoma (ALL), seventeen (22.1%) acute myeloblastic lymphoma (AML) patients and thirty-eight (49.3%) control patients with no known underlying disease or fever were included in this study. Of the 39 patients; 16 (41%) had bacteremia. Mean serum sVCAM1 and sICAM1 levels were significantly higher in control group, compared to FN patients (p < 0.001). Mean serum sVCAM2 level was significantly higher in FN patients with bacteremia compared to FN patients without bacteremia (144.97 ± 70.35 pg/mL vs 85.45 ± 53.76 pg/mL, p = 0.022). Mean sVCAM1 and 2 levels were higher in FN patients with ICU admission. In this study, we found that sVCAM-1 and VEGF, when combined to CRP and PCT, could predict gram-negative bacteremia in FN episodes of pediatric hematological malignancy. CONCLUSION Serum endothelial adhesion molecules, excluding sVCAM-1, cannot predict bacteremia and ICU admission alone in FN patients; but may be associated with clinical outcome when used with PCT and CRP.
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Affiliation(s)
- Kamile Arıkan
- Health Sciences University, Izmir Behcet Uz Children's Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey.
| | - Eda Karadağ-Oncel
- Health Sciences University, Izmir Tepecik Research and Training Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Selin Aytac
- Hacettepe University Faculty of Medicine, Pediatric Hematology Unit, Ankara, Turkey
| | - Ali Bülent Cengiz
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey
| | | | - Ates Kara
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey
| | - Mehmet Ceyhan
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey
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18
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Jantarathaneewat K, Apisarnthanarak A, Limvorapitak W, Weber DJ, Montakantikul P. Pharmacist-Driven Antibiotic Stewardship Program in Febrile Neutropenic Patients: A Single Site Prospective Study in Thailand. Antibiotics (Basel) 2021; 10:antibiotics10040456. [PMID: 33920541 PMCID: PMC8072986 DOI: 10.3390/antibiotics10040456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/11/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022] Open
Abstract
The antibiotic stewardship program (ASP) is a necessary part of febrile neutropenia (FN) treatment. Pharmacist-driven ASP is one of the meaningful approaches to improve the appropriateness of antibiotic usage. Our study aimed to determine role of the pharmacist in ASPs for FN patients. We prospectively studied at Thammasat University Hospital between August 2019 and April 2020. Our primary outcome was to compare the appropriate use of target antibiotics between the pharmacist-driven ASP group and the control group. The results showed 90 FN events in 66 patients. The choice of an appropriate antibiotic was significantly higher in the pharmacist-driven ASP group than the control group (88.9% vs. 51.1%, p < 0.001). Furthermore, there was greater appropriateness of the dosage regimen chosen as empirical therapy in the pharmacist-driven ASP group than in the control group (97.8% vs. 88.7%, p = 0.049) and proper duration of target antibiotics in documentation therapy (91.1% vs. 75.6%, p = 0.039). The multivariate analysis showed a pharmacist-driven ASP and infectious diseases consultation had a favorable impact on 30-day infectious diseases-related mortality in chemotherapy-induced FN patients (OR 0.058, 95%CI:0.005–0.655, p = 0.021). Our study demonstrated that pharmacist-driven ASPs could be a great opportunity to improve antibiotic appropriateness in FN patients.
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Affiliation(s)
- Kittiya Jantarathaneewat
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
- Department of Pharmaceutical care, Faculty of Pharmacy, Thammasat University, Pathum Thani 12120, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
| | - Wasithep Limvorapitak
- Division of Hematology, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
| | - David J. Weber
- School of Global Public Health, University of North Carolina, Gillings, Chapel Hill, NC 27599-7400, USA;
| | - Preecha Montakantikul
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
- Correspondence: ; Tel.: +66-0-2644-8694
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19
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Ohmoto A, Fuji S. Infection profiles of different chemotherapy regimens and the clinical feasibility of antimicrobial prophylaxis in patients with DLBCL. Blood Rev 2020; 46:100738. [PMID: 32747325 DOI: 10.1016/j.blre.2020.100738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022]
Abstract
Various chemotherapy regimens are used to treat patients with diffuse large B-cell lymphoma (DLBCL). However, treatment-related toxicity with a focus on infectious disease has not been fully reviewed. Several phase 3 trials have demonstrated different rates of febrile neutropenia (FN) between regimens (e.g. dose-adjusted (DA) EPOCH-R vs. R-CHOP). With heterogeneous patient characteristics, a combination regimen of lenalidomide or ibrutinib with R-CHOP exhibited promising efficacy with moderate infectious toxicity. While R-bendamustine is feasible for patients who don't tolerate other forms of chemotherapy, clinical data indicate increased opportunistic infections under prolonged lymphopenia. The usefulness of prophylactic antibiotics/antifungal agents in DLBCL patients is controversial owing to shorter and less severe neutropenia than with the induction regimen for acute leukemia or hematopoietic stem-cell transplantation. Prophylactic granulocyte-colony stimulating factor is recommended for intensive regimens such as DA-EPOCH-R, R-DHAP, or R-ICE. Regardless of multiple studies about FN incidence, studies focusing on microbiologic events are limited, and further investigations are warranted.
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Affiliation(s)
- Akihiro Ohmoto
- Division of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 1358550, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka 5418567, Japan.
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20
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Lange CS, Rahrig A, Althouse SK, Nelson RP, Batra S. Hypogammaglobulinemia in Adolescents and Young Adults with Acute Lymphoblastic Leukemia. J Adolesc Young Adult Oncol 2020; 9:687-692. [PMID: 32668180 DOI: 10.1089/jayao.2020.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hypogammaglobulinemia is a poorly described complication of chemotherapy in adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL). The majority of AYAs treated on a Berlin-Frankfurt-Munster-based ALL regimen experienced hypogammaglobulinemia (65.0% [13/20]). Febrile neutropenia episodes (throughout the treatment course) and infectious events during maintenance occurred more frequently in hypogammaglobulinemic patients compared with patients with normal immunoglobulin G levels (n = 7) (median 1.0 vs. 0.0, p = 0.02; 7.0 vs. 3.0, p = 0.02, respectively). Hypogammaglobulinemia did not impact overall or event-free survival. Further studies are needed to elucidate the etiology of hypogammaglobulinemia and to establish criteria for immunoglobulin replacement in these patients.
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Affiliation(s)
| | - April Rahrig
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Pediatric Hematology and Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Sandra K Althouse
- Department of Biostatistics and Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert P Nelson
- Department of Pediatric Hematology and Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandeep Batra
- Department of Pediatric Hematology and Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA.,Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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21
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He N, Dong F, Liu W, Zhai S. A Systematic Review of Vancomycin Dosing in Patients with Hematologic Malignancies or Neutropenia. Infect Drug Resist 2020; 13:1807-1821. [PMID: 32606830 PMCID: PMC7305817 DOI: 10.2147/idr.s239095] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/04/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To provide a comprehensive review of vancomycin dosing in patients with hematologic malignancies or neutropenia. Methods PubMed, Embase and the Cochrane Library were searched through April 2, 2020. Original studies relevant to vancomycin dosing regimen in adults with hematologic malignancies or neutropenia were included. No restriction was applied in study design and language. A descriptive analysis was performed. Results Twenty-three studies were included eventually, of which eighteen were case series studies, four were cohort studies and another one was a randomized controlled trial. Five case series studies made a clinical audit of conventional vancomycin dosing in patients with malignancies or neutropenia, showing that the proportion of patients with sub-therapeutic trough levels remained high, ranging from 32% to 88%. Seven case series studies and four cohort studies demonstrated that vancomycin clearance (CLva) tended to be higher in patients with hematologic malignancies or neutropenia, whereas volume of distribution (V) seemed to be comparable to the control group. Five studies proposed individualized initial dosing regimen per the pharmacokinetic changes; however, no prospective validation has been conducted in clinical setting. Additionally, four case series studies suggested that the correlation between vancomycin clearance and estimated creatinine clearance was relatively poor, bringing a great challenge to proper dosing strategy. A randomized controlled trial stated that therapeutic drug monitoring (TDM) of vancomycin could decrease the incidence of nephrotoxicity in immunocompromised febrile patients with hematologic malignancies. Conclusion The available evidence indicates that conventional vancomycin dosing leads to suboptimal concentration in patients with hematologic malignancy or neutropenia. TDM accompanied by pharmacokinetic interpretation can decrease the risk of nephrotoxicity. The individualization of the initial dosing regimen and mechanisms of augmented clearance require further research.
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Affiliation(s)
- Na He
- Department of Pharmacy, Peking University Third Hospital, Beijing, People's Republic of China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, People's Republic of China
| | - Fei Dong
- Department of Hematology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Liu
- Department of Pharmacy, Peking University Third Hospital, Beijing, People's Republic of China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, People's Republic of China
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22
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Nurse-initiated pre-prescribed antibiotic orders to facilitate prompt and appropriate antibiotic administration in febrile neutropenia. Support Care Cancer 2020; 28:4337-4343. [PMID: 31912358 DOI: 10.1007/s00520-019-05290-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/29/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the impact of a pathway allowing nurse initiation of first dose intravenous (IV) antibiotics on time to antibiotic administration (TTA) in adult inpatients with febrile neutropenia (FN). METHODS This study evaluated the impact on TTA of a clinical pathway (November 2017 to April 2018) allowing nurse initiation of pre-prescribed antibiotics in adult haematology patients with FN, compared with a prior cohort (November 2016 to April 2017) in which antibiotics were only prescribed and administered after medical review. The primary endpoint for comparison was TTA, calculated as the time between the first recorded fever and IV antibiotic administration. Secondary endpoints included appropriateness of initial antibiotic choice, 30-day all-cause mortality and admission to intensive care unit (ICU). RESULTS Forty-seven eligible FN episodes in 40 patients and 61 episodes in 52 patients were evaluated in the pre- and post-implementation groups, respectively. Baseline characteristics were comparable between groups. Median (IQR) TTA, in the pre-implementation group [66 min (40-100 min)] was significantly prolonged versus post-implementation group [29 min (20-41 min); p < 0.001]. A significantly higher proportion of episodes were administered appropriate initial antibiotics in the post-versus pre-implementation groups (100% vs. 89%, p = 0.03). There was no significant change in 30-day all-cause mortality (0% vs. 5%, p = 0.3) or ICU admission within 48 h of fever (0% vs. 2%, p > 0.99) between pre- and post-implementation groups, respectively. CONCLUSIONS A pathway allowing nurse initiation of pre-prescribed antibiotic orders for FN significantly reduced TTA from first recorded fever and increased the proportion of appropriate initial antibiotic choices without significantly impacting on patient outcomes.
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23
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Alsfeld LC, Rockey DC. Utility of Routine Blood Cultures for Inpatient Hematology/Oncology Patients Receiving Antimicrobials. Am J Med Sci 2019; 358:175-181. [DOI: 10.1016/j.amjms.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 12/22/2022]
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24
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A Novel Severity Score Index for Febrile Neutropenic Patients with Colorectal Diseases. Gastroenterol Res Pract 2019; 2019:4175960. [PMID: 31019530 PMCID: PMC6451812 DOI: 10.1155/2019/4175960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/15/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction Abdominal and anorectal disorders may be the cause of clinical decompensation in neutropenic febrile patients, particularly those with hematologic diseases. Infection is a cause for concern for the colorectal surgeon. Some conditions have few manifestations and can lead to death within a short period of time. This study presents the novel colorectal disorder severity score for febrile neutropenic patients. Materials and Methods This was a case series study analyzing the medical records of 897 patients admitted to the Hematology and Hematopoietic Stem Cell Transplant Unit in a university hospital between the years 2008 and 2013. Seventy-four episodes of febrile neutropenia in 69 patients diagnosed with an abdominal or anorectal infection site were eligible for the study. The new scoring system proposed here is based on the author's clinical experience and an extensive literature review. In addition to the extensive literature review, effect measures were calculated, and a statistical analysis was performed. Based on an evaluation of common biological plausibility criteria, five factors were selected as the main predictors of hospital mortality in febrile neutropenic patients with colorectal disease. Results The proposed score demonstrated increased mortality as the condition worsened as reflected by an increasing score (Fisher's exact test: 0.001). When considering the logistic model for the probability of death by score level, the AUC value was 0.82 (0.72-0.925), and the Hosmer-Lemeshow statistic value was 2.3, p = 0.806. Conclusion The proposed scoring system allows prediction of the likelihood of death during hospitalization for febrile neutropenic patients with an abdominal and anorectal focus. New studies on the subject are required, and the proposed scoring scale must be validated on a larger and different sample of patients.
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Factors associated with emergent colectomy in patients with neutropenic enterocolitis. Langenbecks Arch Surg 2019; 404:327-334. [PMID: 30953135 DOI: 10.1007/s00423-019-01781-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Neutropenic enterocolitis (NEC) is a severe complication of neutropenia. NEC is characterized by segmental ulceration, intramural inflammation, and necrosis. Factors present in patients who underwent colectomy have never been studied. The present study aimed to describe the clinical factors present in patients who underwent emergent colectomy for the treatment of neutropenic enterocolitis. METHODS Patients admitted with neutropenic enterocolitis from November 2009 to May 2018 were retrospectively analyzed. Logistic regression analysis was used to determine clinical factors associated with emergent colectomy. RESULTS Thirty-nine patients with NEC were identified. All patients had a hematological disorder. Medical treatment was the only management in 30 (76.9%) patients, and 9 (23.1%) patients underwent colectomy. No differences were found between the treatment groups regarding sex, age, or comorbidities. Patients were more likely to undergo colectomy if they developed abdominal distention (OR = 12, p = 0.027), hemodynamic failure (OR = 6, p = 0.042), respiratory failure (OR = 17.5, p = 0.002), multi-organic failure (OR = 9.6, p = 0.012), and if they required ICU admission (OR = 11.5, p = 0.007). Respiratory failure was the only independent risk factor for colectomy in multivariable analysis. In-hospital mortality for the medical and surgical treatment groups was 13.3% (n = 4) and 44.4% (n = 4), respectively (p = 0.043). CONCLUSIONS In our study, most NEC patients were treated conservatively. Patients were more likely to undergo colectomy if they developed organ failures or required ICU admission. Early surgical consultation is suggested in all patients with NEC.
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Soltermann Y, Heim D, Medinger M, Baldomero H, Halter JP, Gerull S, Arranto C, Passweg JR, Kleber M. Reduced dose of post-transplantation cyclophosphamide compared to ATG for graft-versus-host disease prophylaxis in recipients of mismatched unrelated donor hematopoietic cell transplantation: a single-center study. Ann Hematol 2019; 98:1485-1493. [DOI: 10.1007/s00277-019-03673-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 03/17/2019] [Indexed: 01/08/2023]
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Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia. Support Care Cancer 2019; 27:4171-4177. [PMID: 30805726 DOI: 10.1007/s00520-019-04701-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/11/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine if time to antibiotics (TTA) improves outcomes of hospital length of stay, admission to the intensive care unit, and 30-day mortality in adult patients with febrile neutropenia. METHODS This retrospective cohort study evaluated the impact of time to antibiotic, in the treatment of febrile neutropenia, on hospital length of stay, admission to the intensive care unit, and 30-day mortality. Cases included were patients 18 years or older hospitalized with febrile neutropenia from August 1, 2006 to July 31, 2016. To adjust for other characteristics associated with hospital length of stay, admission to the intensive care unit, and 30-day mortality, a multivariate analysis was performed. RESULTS A total of 3219 cases of febrile neutropenia were included. The median hospital length of stay was 7.0 days (IQR 4.1-13.3), rate of intensive care unit admission was 13.6%, and 30-day mortality was 6.6%. Multivariate analysis demonstrated time to antibiotics was not associated with hospital length of stay but was associated with admission to the intensive care unit admission and 30-day mortality. Delays in time to antibiotic of up to 3 hours did not impact outcomes. CONCLUSIONS A shorter time to antibiotic is important in treatment of febrile neutropenia; however, moderate delays in antibiotic administration did not impact outcomes. Further investigation is needed in order to determine if other indicators of infection, in addition to fever, or other supportive management, in addition to antibiotics, are indicated in the early identification and management of infection in patients with neutropenia.
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Ge J, Yang T, Zhang L, Zhang X, Zhu X, Tang B, Wan X, Tong J, Song K, Yao W, Sun G, Sun Z, Liu H. The incidence, risk factors and outcomes of early bloodstream infection in patients with malignant hematologic disease after unrelated cord blood transplantation: a retrospective study. BMC Infect Dis 2018; 18:654. [PMID: 30545330 PMCID: PMC6293544 DOI: 10.1186/s12879-018-3575-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 11/30/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Bloodstream infection (BSI) is one of the major causes of morbidity and mortality for patients undergoing hematopoietic stem cell transplantation (HSCT). The unrelated cord blood transplantation (UCBT) can provided opportunities for patients without suitable donors for bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT), while few studies have addressed BSI after UCBT. The aim of this study was to analyse the incidence and risk factors of BSI, causative organisms, microbial resistance, and its impact on the clinical outcomes and survival of patients. METHODS There are 336 patients, were divided into two groups depending on whether developing BSI. Demographic characteristics, laboratory data, and clinical outcome were compared between different groups. The risk factors of BSI was examined using logistic regression and the survival was examined using the Kaplan-Meier method and log-rank test. RESULTS Ninety-two patients (27.4%) developed early BSI with 101 pathogenic bacteria isolated, and the median day of developing initial BSI was 4.5 d. Gram-negative bacteria were the most common isolate (60, 59.4%), followed by Gram-positive bacteria (40, 39.6%) and fungi (1, 1.0%). Thirty-seven (36.6%) isolates were documented as having multiple drug resistance (MDR). Myeloid malignancies, conditioning regimens including total body irradiation (TBI), and prolonged neutropenia were identified as the independent risk factors for early BSI. The 3-year OS was 59.9% versus 69.2% in the BSI group and no-BSI group (P = 0.0574), respectively. The 3-year OS of the MDR group was significantly lower than that of the non-BSI group (51.1% versus 69.2%, p = 0.013). CONCLUSIONS Our data indicate that the incidence of early BSI after UCBT was high, especially in patients with myeloid disease and a conditioning regimen including TBI and prolonged neutropenia. Early BSI with MDR after UCBT had a negative impact on long-term survival.
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Affiliation(s)
- Jing Ge
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Tingting Yang
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Lei Zhang
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xuhan Zhang
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xiaoyu Zhu
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Baolin Tang
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xiang Wan
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Juan Tong
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Kaidi Song
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Wen Yao
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Guangyu Sun
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zimin Sun
- Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Huilan Liu
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, 17 Lujiang Road, Hefei, 230001, Anhui, China. .,Department of Hematology of Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, Anhui, China.
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Nordvig J, Aagaard T, Daugaard G, Brown P, Sengeløv H, Lundgren J, Helleberg M. Febrile Neutropenia and Long-term Risk of Infection Among Patients Treated With Chemotherapy for Malignant Diseases. Open Forum Infect Dis 2018; 5:ofy255. [PMID: 30377628 PMCID: PMC6201153 DOI: 10.1093/ofid/ofy255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/12/2018] [Indexed: 11/14/2022] Open
Abstract
Background Febrile neutropenia (FN) is a common complication to chemotherapy, associated with increased short-term morbidity and mortality. However, the long-term outcomes after FN are poorly elucidated. We examined the long-term risk of infection and mortality rates in cancer patients with and without FN. Methods Patients aged >16 years treated with firstline chemotherapy were followed from 180 days after initiating chemotherapy until first infection, a new treatment with chemotherapy, death, or end of follow-up. Risk factors for infections were analyzed by competing risks regression, with death or another treatment with chemotherapy as competing events. Adjusted incidence rate ratios (aIRRs) of infection and death were analyzed using Poisson regression. In analyses of mortality, infection was included as a time-updated variable. Results We included 7190 patients with a median follow-up (interquartile range) of 0.58 (0.20–1.71) year. A total of 1370 patients had an infection during follow-up. The aIRRs of infection were 1.86 (95% confidence interval [CI], 1.56–2.22) and 2.19 (95% CI, 1.54–3.11) for patients with 1 or >1 episode of FN compared with those without FN. Mortality rate ratios were 7.52 (95% CI, 6.67–8.48) <1 month after, 4.24 (95% CI, 3.80–4.75) 1–3 months after, 2.33 (95% CI, 1.63–3.35) 3–6 months after, and 1.09 (95% CI, 0.93–1.29) >6 months after an infection, compared with the time before infection. Conclusions FN during chemotherapy is associated with a long-term increased risk of infection. Mortality rates are substantially increased for 6 months following an infection.
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Affiliation(s)
- Josefine Nordvig
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Theis Aagaard
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Peter Brown
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Henrik Sengeløv
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jens Lundgren
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Marie Helleberg
- Centre for Health, Immunity and Infections (CHIP), Copenhagen University Hospital, Rigshospitalet, Denmark
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Tansir G, Rastogi N, Ramteke P, Kumar P, Soneja M, Biswas A, Kumar S, Jorwal P, Baitha U. Disseminated mucormycosis: A sinister cause of neutropenic fever syndrome. Intractable Rare Dis Res 2017; 6:310-313. [PMID: 29259862 PMCID: PMC5735287 DOI: 10.5582/irdr.2017.01063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 15 year old girl presented with complaints of prolonged fever and recurrent episodes of hemoptysis. Initial investigation showed pancytopenia and radiological imaging was suggestive of necrotizing pneumonia. Subsequently, mucor was isolated from bronchoalveolar lavage fluid, but even on appropriate medications her condition kept deteriorating. She had multiple bouts of hemoptysis and a repeat imaging of chest showed dissemination of mucormycosis to pulmonary vein and heart. Bone marrow biopsy identified acute lymphoblastic leukemia (ALL) as the cause of pancytopenia. She was planned for bronchial artery embolization and chemotherapy for ALL, but consent was not given and she left our institute against medical advice. Our case highlights the importance of keeping a high index of suspicion for disseminated mucormycosis in neutropenic patients, as any delay in diagnosis and treatment could have grave consequences.
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Affiliation(s)
- Ghazal Tansir
- Department of Medicine, All India Institute of Medical Science, New Delhi, India
| | - Neha Rastogi
- Division of Infectious Disease, Department of Medicine and Microbiology. All India Institute of Medical Science, New Delhi, India
| | - Prashant Ramteke
- Department of Pathology, All India Institute of Medical Science, New Delhi, India
| | - Prabhat Kumar
- Department of Medicine, All India Institute of Medical Science, New Delhi, India
- Address correspondence to: Dr. Prabhat Kumar, Department of Medicine, 3rd floor, Teaching Block, All India Institute of Medical Science, New Delhi 110029, India. E-mail:
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Science, New Delhi, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Science, New Delhi, India
| | - Sanchit Kumar
- Department of Medicine, All India Institute of Medical Science, New Delhi, India
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Science, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Science, New Delhi, India
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Andrès E, Mourot-Cottet R, Maloisel F, Keller O, Vogel T, Séverac F, Tebacher M, Gottenberg JE, Weber JC, Kaltenbach G, Goichot B, Sibilia J, Korganow AS, Herbrecht R. History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs. J Clin Med 2017; 6:E92. [PMID: 28954408 PMCID: PMC5664007 DOI: 10.3390/jcm6100092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital. PATIENTS AND METHODS Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg, France). RESULTS Mean patient age was 52.2 years old (range: 18-93) and gender ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%), neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main clinical presentations upon hospitalization included isolated fever (30%), sore throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%), septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was 0.13 × 10(9)/L (range: 0-0.48). While in hospital, 22 patients (28.9%) worsened clinically and required intensive care unit placement. All patients were promptly treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth factors. Mean duration of hematological recovery (neutrophil count ≥1.5 × 10(9)/L) was 7.5 days (range: 2-21), which was reduced to 0.7 days (range: 2-16) (p = 0.089) with hematopoietic growth factors. Outcome was favorable in 89.5% of patients, whereas eight died. CONCLUSIONS Like in oncology and myelosuppressive chemotherapy settings, idiosyncratic febrile neutropenia is typically serious, about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock, with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia, modern and timely management (immediate broad spectrum antibiotherapy, hematopoietic growth factors) may reduce infection-related mortality. All practitioners should be aware of this potential side-effect that may even occur in the event of "daily medication" exposure.
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Affiliation(s)
- Emmanuel Andrès
- Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Rachel Mourot-Cottet
- Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Frédéric Maloisel
- Departments of Onco-hematology, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Olivier Keller
- Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Thomas Vogel
- Departments of Geriatrics, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - François Séverac
- Departments of Statistics, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Martine Tebacher
- Regional Pharmacovigilance Centre of Alsace, Strasbourg 67000, France.
| | | | | | - Georges Kaltenbach
- Departments of Geriatrics, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Bernard Goichot
- Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Jean Sibilia
- Departments of Rheumatology, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Anne-Sophie Korganow
- Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France.
| | - Raoul Herbrecht
- Departments of Onco-hematology, Strasbourg University Hospitals, Strasbourg 67000, France.
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Kunstel KL. Oncologic Emergencies. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zhang L, Lu HW, Liu HL, Zhu XY, Tang BL, Zheng CC, Yang HZ, Geng LQ, Ding KY, Wang XB, Han YS, Liu X, Wu JS, Zhu WW, Cai XY, Sun ZM. [Pathogens and clinical characteristics of bacterial infection in hematology department between 2010 and 2014]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:383-7. [PMID: 27210872 PMCID: PMC7348313 DOI: 10.3760/cma.j.issn.0253-2727.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyze the characteristics of distribution and drug resistance of bacterial infection in several different parts of hematology department inpatients of Anhui Provincial Hospital from January 2010 to December 2014, including patients who had received hematopoietic stem cell transplantation (HSCT). METHODS Anti-microbial susceptibility test was done by Kirby-Bauer method and automated systems and the data were analysed by WHONET 5.6 software. RESULTS A total of 3 312 copies of inspection samples were analyzed, including 2 716 (82%) blood samples and other 596 specimens (18%). 634 bacterial strains were isolated from 3 312 samples (19.14%) including 488 samples (76.97%) from blood culture. 427 (67.35%) bacterial strains were gram-negative, and the other 207 (32.65%) were gram-positive. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were most common gram-negative bacterial and the resistant rates to imipenem were 0.8%, 11.8% and 3.3%, respectively. Detection rates of Extended-spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae were 83.9% and 75.0%, respectively. At the same time, Coagulase negative Staphylococcus, Streptococcus and Enterococcus were most common kinds of gram-positive bacteria. Methicillin-resistant coagulase negative staphylococcus accounted for 65.9% antibiotic resistance. No vancomycin and/or linezolid and/or tigecycline resistant strains of Staphylococcus spp. and Enterococcus spp. were found in those patients. CONCLUSION Patients with hematology diseases had a higher risk of bacterial infections, mainly caused by Gram-negative bacteria. There are different distributions of bacterial in different wards.
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Affiliation(s)
- L Zhang
- Department of Hematology, Affiliated Provincial Hospital, Anhui Medical University, Hefei 230001, China
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Piukovics K, Terhes G, Lázár A, Tímár F, Borbényi Z, Urbán E. Evaluation of Bloodstream Infections During Chemotherapy-Induced Febrile Neutropenia in Patients with Malignant Hematological Diseases: Single Center Experience. Eur J Microbiol Immunol (Bp) 2015; 5:199-204. [PMID: 26495130 PMCID: PMC4598887 DOI: 10.1556/1886.2015.00021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/26/2015] [Indexed: 11/19/2022] Open
Abstract
From year to year, it is important to get an overview of the occurrence of causative agents in febrile neutropenic patients to determine the empiric treatment. Thus our aims were to evaluate a four-year period regarding the prevalence of bloodstream infections and the most important causative agents. During this period, 1,361 patients were treated in our hematology ward because of various hematological disorders. 812 febrile episodes were recorded in 469 patients. At that time, 3,714 blood culture (BC) bottles were sent for microbiological investigations, 759 of them gave positive signal. From the majority of positive blood culture bottles (67.1%), Gram-positive bacteria, mainly coagulase-negative staphylococci (CNS), were grown. Gram-negative bacteria were isolated from 32.9% of the positive blood culture bottles, in these cases the leading pathogen was Escherichia coli. The high prevalence of CNS was attributed to mainly contamination, while lower positivity rate for Gram-negative bacteria was associated with the use of broad-spectrum empiric antibiotic treatment.
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Affiliation(s)
- Klára Piukovics
- Second Department of Internal Medicine and Cardiological Center, University of Szeged , Szeged, Hungary
| | - Gabriella Terhes
- Institute of Clinical Microbiology, University of Szeged , Szeged, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, University of Szeged , Szeged, Hungary
| | - Flóra Tímár
- Second Department of Internal Medicine and Cardiological Center, University of Szeged , Szeged, Hungary
| | - Zita Borbényi
- Second Department of Internal Medicine and Cardiological Center, University of Szeged , Szeged, Hungary
| | - Edit Urbán
- Institute of Clinical Microbiology, University of Szeged , Szeged, Hungary
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Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Adv Hematol 2014; 2014:986938. [PMID: 25525436 PMCID: PMC4265549 DOI: 10.1155/2014/986938] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/18/2014] [Accepted: 11/03/2014] [Indexed: 01/27/2023] Open
Abstract
Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis.
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