Evaluation of bloodstream infections in febrile neutropenic patients with hematological malignancy: a retrospective cohort study
Abstract
Background: Patients with hematological malignancies (HMs) are at high risk of bloodstream infections (BSIs) during episodes of febrile neutropenia (FN). However, empirical treatment initiated before isolation of the causative agent from blood cultures is crucial. The aim of this study was to determine the distribution and antimicrobial resistance profile of microorganisms isolated from BSIs in patients with HMs, and to evaluate the association with the need for intensive care unit (ICU) and mortality at 30 days.
Methods: Single-centre data from patients with HMs who were admitted to the hematology inpatient clinic and had a BSI during an episode of FN were retrospectively reviewed.
Results: A total of 164 FN episodes with BSI in 122 patients were analysed. Of the 164 episodes, 56.7% were Gram-negative. The most prevalent Gram-negative bacterium was Escherichia coli (31%). The positivity rate for extended-spectrum beta-lactamase (ESBL) was 49.3%, and the rate of carbapenem resistance was 20.2%. In multivariate analyses restricted to Gram-negative BSIs, carbapenem resistance was independently associated with both 30-day ICU admission and 30-day all-cause mortality, whereas ESBL positivity was not independently associated.
Conclusion: The rates of ESBL positivity and carbapenem resistance in Gram-negative bacteria are notable. However, only carbapenem resistance was independently associated with adverse clinical outcomes. Therefore, in line with regional surveillance data,…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 122 participants or records.
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