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Alonso-Cadenas JA, Sancosmed Ron M, Herrero B, Lera Carballo E, Lassaletta A, Rodrigo R, de la Torre M. Role of urine culture in paediatric patients with cancer with fever and neutropenia: a prospective observational study. Arch Dis Child 2023; 108:982-986. [PMID: 37553208 DOI: 10.1136/archdischild-2023-325992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To evaluate the need for routine urine studies in children with febrile neutropenia with cancer. DESIGN A prospective, observational study was conducted in two hospitals between November 2019 and October 2021. PATIENTS We recruited 205 patients in total. MAIN OUTCOME MEASURES The primary outcome was presence of positive urine culture (UC). Urinary tract infection (UTI) was defined as urinary signs/symptoms and positive UC with or without pyuria. A descriptive analysis of data is provided.We conducted a prospective study of paediatric patients with cancer with urinary continence. Data were analysed using descriptive statistics. The diagnostic performance of urinalysis was calculated using positive UC as the gold standard. RESULTS Positive UC was found in 7 of the 205 patients (3.4%; 95% CI 1.4% to 6.9%), 2 presenting urinary symptoms. UTI prevalence was 1.0% (95% CI 0.1% to 3.5%). A 23.8% prevalence of positive UC was found in patients with urinary symptoms and/or history of urinary tract disease (95% CI 8.2% to 47.2%) as compared with 1.1% of those without symptoms or history (95% CI 0.1% to 3.9%) (p<0.001). The sensitivity, specificity, negative predictive value, and area under the curve for urinalysis were 16.7% (95% CI 3.0% to 56.4%), 98.4% (95% CI 95.3% to 99.4%), 97.3% (95% CI 93.9% to 98.9%), and 0.65 (95% CI 0.51 to 0.79), respectively. CONCLUSIONS UTI is an infrequent cause of infection in these patients. Urinalysis is indicated only in children with febrile neutropenia with urinary signs/symptoms and in asymptomatic patients with a history of urinary tract disease or unknown history. When urine is collected, UC should be requested regardless of the result of the urinalysis.
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Affiliation(s)
- Jose Antonio Alonso-Cadenas
- Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
| | | | - Blanca Herrero
- Paediatric Oncology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | | | - Alvaro Lassaletta
- Pediatric Neuro-oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Rocio Rodrigo
- Paediatric Emergency Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
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Tran M, Palmer S, Moore DT, Bartelt L, Friedland A, Grgic T, Lachiewicz A, Ptachcinski J, Sena A, Trepte M, van Duin D, Andermann TM, Shaw R. Utility of Urine Cultures During Febrile Neutropenia Workup in Hematopoietic Stem Cell Transplantation Recipients Without Urinary Symptoms. Open Forum Infect Dis 2023; 10:ofad236. [PMID: 37265665 PMCID: PMC10230562 DOI: 10.1093/ofid/ofad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
The utility of obtaining screening urine cultures for febrile neutropenia (FN) during hematopoietic stem cell transplant (HCT) is unknown. In 667 adult HCT patients with FN, only 40 (6%) were found with bacteriuria. Antibiotics were modified in 3 patients (0.4%) based on urine cultures and none developed urinary-associated infectious complications.
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Affiliation(s)
- Mya Tran
- Department of Pharmacy, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Shannon Palmer
- Department of Pharmacy, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Dominic T Moore
- Department of Biostatistics, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Luther Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Anne Friedland
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Tatjana Grgic
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Anne Lachiewicz
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Jon Ptachcinski
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Arlene Sena
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Morgan Trepte
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Tessa M Andermann
- Correspondence: Tessa Andermann, MD, MPH, University of North Carolina at Chapel Hill, 111 Mason Farm Road, cb# 7036, Chapel Hill, NC, 27599-7036 (); Ryan Shaw, PharmD, BCPS, BCOP, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC, 27599
| | - Ryan Shaw
- Correspondence: Tessa Andermann, MD, MPH, University of North Carolina at Chapel Hill, 111 Mason Farm Road, cb# 7036, Chapel Hill, NC, 27599-7036 (); Ryan Shaw, PharmD, BCPS, BCOP, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC, 27599
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Delaye T, Torregrosa Diaz JM, Vallée M, Gallego Hernanz MP, Gyan E, Lanotte P, Roblot F, Rammaert B. Outcome of febrile neutropenic patients treated for bacteriuria in hematology. Support Care Cancer 2023; 31:102. [PMID: 36622445 DOI: 10.1007/s00520-022-07522-4] [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: 12/13/2021] [Accepted: 11/02/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Positive urine sample is a frequent finding in post-chemotherapy febrile neutropenia (FN) and can lead to prolonged antibiotic therapy. The aim of this study was to assess the outcome of bacteriuria episodes in FN patients receiving targeted antibiotic therapy. MATERIALS AND METHODS A multi-centric retrospective study was conducted over a four-year period (2014-2019) on systematic urinalysis. All consecutive first bacteriuria episodes (≤ 2 bacteria with at least ≥ 103 CFU/mL) during FN in hospitalized adult patients for hematological malignancies were included. Relapse and recurrence were defined by fever or urinary tract symptoms (UTS) with the same bacterial subspecies in urine occurring ≤ 7 days and ≤ 30 days, respectively, after antibiotic discontinuation. Mortality rate was determined at 30 days. Targeted antibiotic therapy ≤ 10 days for women and ≤ 14 for men was considered as short course. RESULTS Among 97 patients, 105 bacteriuria episodes on systematic urinalysis were analyzed; 67.6% occurred in women, 41.9% in AML patients, 17.1% were bacteremic, 14.2% presented with UTS, and 61.9% were treated with short-course antibiotic treatment. One death was reported. In men, no relapse/recurrence was noted, even in the short-course antibiotic group. In women, 2.8% of episodes treated with short-course antibiotic led to relapse or recurrence. CONCLUSIONS Relapse, recurrence, and mortality were uncommon events in FN patients experiencing bacteriuria episode, whatever the antibiotic duration. To distinguish asymptomatic bacteriuria from infection remained challenging in women. In men, systematic urinalysis at onset of FN could be useful.
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Affiliation(s)
- Thomas Delaye
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France.,CHU de Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France
| | | | - Maxime Vallée
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France.,CHU de Poitiers, Service de Chirurgie Urologique et de Transplantations Rénales, Poitiers, France.,INSERM U1070, Poitiers, France
| | | | - Emmanuel Gyan
- CHU de Tours, Service d'Hématologie Et Thérapie Cellulaire, Equipe LNOx CNRS ERL 7001, Tours, France
| | - Philippe Lanotte
- CHU de Tours, Service de Bactériologie Département des Agents Infectieux Tours, Poitiers, France
| | - France Roblot
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France.,CHU de Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France.,INSERM U1070, Poitiers, France
| | - Blandine Rammaert
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France. .,CHU de Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France. .,INSERM U1070, Poitiers, France. .,Service de Médecine Interne et Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, CS 90577, Cedex, 86021, Poitiers, France.
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Zgheib H, Zakhem AE, Wakil C, Cheaito MA, Cheaito R, Finianos A, Chebl RB, Kaddoura R, Souky NA, Majzoub IE. Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department. World J Emerg Med 2021; 12:99-104. [PMID: 33728001 DOI: 10.5847/wjem.j.1920-8642.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The role of urine studies in the detection of urinary tract infection (UTI) in febrile neutropenic patients with urinary symptoms (having a urinary catheter or having a positive urine analysis) is inarguable. However, the evidence is scarce regarding the indication for urine studies in asymptomatic (i.e., without urinary symptoms) patients with febrile neutropenia (FN) presenting to the emergency department (ED). The aim of this study is to evaluate the need for obtaining urine studies in asymptomatic febrile neutropenic patients. METHODS This was a retrospective cohort study conducted on adult cancer patients who presented to the ED with FN and had no urinary symptoms. We included all ED presentations of eligible patients between January 2013 and September 2018. Student's t-test and Wilcoxon rank-sum test were used for continuous data, while Chi-square and Fisher's exact tests were used for categorical data. Participants were divided into two groups based on their urine culture (UC) results: negative and positive UCs. Two cut-offs were used for positive UC results: ≥105 cfu/mL and ≥104 cfu/mL. RESULTS We included 284 patients in our study. The age of our patient population was 48.5±18.5 years. More than two-thirds (68.7%) of patients had severe neutropenia, while only 3.9% and 9.9% of the patients had positive UCs at ≥105 cfu/mL and ≥104 cfu/mL, respectively. UCs were expectedly positive in most patients with urinalysis (UA) abnormalities. However, 27.3% and 32.1% of patients with positive UCs at ≥105 cfu/mL and ≥104 cfu/mL respectively had a normal UA. CONCLUSIONS In our study, the incidence of UTI in adult febrile neutropenic cancer patients who present to the ED without urinary symptoms is low. Consequently, routine urine testing may not be warranted in this population, as it adds unnecessary financial burdens on the patients and delays timely management.
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Affiliation(s)
- Hady Zgheib
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Aline El Zakhem
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Cynthia Wakil
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Mohamad Ali Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Rola Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Antoine Finianos
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Rima Kaddoura
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Nader Al Souky
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
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Grigg SE, Date P, Loh Z, Estacio O, Johnson DF, Hawkes EA, Grigg A. Urine cultures at the onset of febrile neutropenia rarely impact antibiotic management in asymptomatic adult cancer patients. Support Care Cancer 2018; 27:1223-1227. [PMID: 30259115 DOI: 10.1007/s00520-018-4476-7] [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: 05/21/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is a paucity of data regarding the utility of routine urine cultures in adults with febrile neutropenia (FN) without urinary symptoms receiving protocolised antibiotics. This is reflected by inconsistent recommendations in international and regional FN guidelines. We addressed this issue by retrospectively reviewing the impact of routine urine cultures on antibiotic management in haematology cancer inpatients at a tertiary hospital. METHODS All haematology inpatients over a 5-year period (2011-2015) were retrospectively reviewed for episodes of FN (neutrophil count < 0.5 × 109/L and fever > 37.5 °C). For each episode, demographic data, urinary tract symptoms and signs (absence of which was termed 'asymptomatic'), urinalysis and urine culture results, antibiotic therapy and duration, and patient outcomes were collected. A urine culture was considered positive if > 105 colony forming units (CFU)/L were detected. Empiric antibiotic therapy for FN consisted of intravenous piperacillin/tazobactam in stable patients, with the addition of vancomycin and a single dose of gentamicin if systemically compromised. RESULTS Four hundred and thirty-three episodes of FN were identified in 317 patients. Urine cultures were performed in 362 (84%) episodes. Cultures were positive in 9 of 48 (19%) symptomatic episodes versus 8 of 314 (2.5%) asymptomatic episodes (RR = 7.4, p < 0.0001). A change in antibiotic management due a positive urine culture occurred in only 5 episodes (1.4%): 3 of 48 (6.3%) symptomatic and 2 of 314 (0.6%) asymptomatic episodes respectively (RR = 9.8, p = 0.01). CONCLUSION Routine urine cultures in FN patients without urinary symptoms who are already receiving protocolised broad spectrum antibiotics rarely impact subsequent antibiotic management.
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Affiliation(s)
- Sam E Grigg
- University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Date
- University of Melbourne, Parkville, Victoria, Australia
| | - Zoe Loh
- University of Melbourne, Parkville, Victoria, Australia
| | - Ortis Estacio
- University of Melbourne, Parkville, Victoria, Australia
| | - Douglas F Johnson
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Eliza A Hawkes
- University of Melbourne, Parkville, Victoria, Australia.,Department of Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Andrew Grigg
- University of Melbourne, Parkville, Victoria, Australia. .,Department of Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia. .,Olivia Newton John Cancer Research Institute, Heidelberg, Victoria, Australia.
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