Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia.

Autor: Albasanz-Puig A; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain., Durà-Miralles X; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain., Laporte-Amargós J; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain., Mussetti A; Hematology Department, Catalan Institute of Oncology (ICO)-Duran i Reynals Hospital, IDIBELL, 08907 Barcelona, Spain., Ruiz-Camps I; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.; Infectious Diseases Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain., Puerta-Alcalde P; Infectious Diseases Department, Hospital Clínic i Provincial, 08035 Barcelona, Spain., Abdala E; Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo, Sao Paulo 01246, Brazil., Oltolini C; Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy., Akova M; Department of Infectious Diseases, Hacettepe University School of Medicine, 06230 Ankara, Turkey., Montejo JM; Infectious Diseases Department, Cruces University Hospital, 48903 Bilbao, Spain., Mikulska M; Division of Infectious Diseases, Department of Health Sciences, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, 16132 Genoa, Italy., Martín-Dávila P; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.; Infectious Diseases Department, Ramon y Cajal Hospital, 28034 Madrid, Spain., Herrera F; Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1430EFA, Argentina., Gasch O; Infectious Diseases Department, Parc Taulí University Hospital, Sabadell, 08208 Barcelona, Spain., Drgona L; Oncohematology Department, Comenius University and National Cancer Institute, 81499 Bratislava, Slovakia., Morales HMP; Infectious Diseases Department, Hospital Erasto Gaertner, Curitiba 81520-060, Brazil., Brunel AS; Infectious Diseases Department, Department of Medicine, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland., García E; Haematology Department, Reina Sofía University Hospital-IMIBIC-UCO, 14004 Córdoba, Spain., Isler B; Department of Infectious Diseases and Clinical Microbiology, Istanbul Education and Research Hospital, Istanbul 34668, Turkey., Kern WV; Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Center and Faculty of Medicine, 79110 Freiburg, Germany., Retamar-Gentil P; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.; Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Department of Medicine, Universidad de Sevilla, Institute of Biomedicine of Seville, Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, 41013 Seville, Spain., Aguado JM; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.; Infectious Diseases Unit, Instituto de Investigación Hospital '12 de Octubre' (i + 12), '12 de Octubre' University Hospital, School of Medicine, Universidad Complutense, 28041 Madrid, Spain., Montero M; Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigations Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain., Kanj SS; Infectious Diseases Division, American University of Beirut Medical Center, Beirut 110236, Lebanon., Sipahi OR; Faculty of Medicine, Ege University, Izmir 35040, Turkey., Calik S; Department of Infectious Diseases and Clinical Microbiology, University of Health Science Izmir Bozyaka Training and Research Hospital, Izmir 35170, Turkey., Márquez-Gómez I; Infectious Diseases Department, Hospital Regional de Málaga, 29010 Málaga, Spain., Marin JI; Infectious Diseases and Clinical Microbiology Department, Clínica Maraya, Pereira, Colombia, Critical Care and Clinical Microbiology Department, Manizales 170001-17, Colombia., Gomes MZR; Hospital Federal dos Servidores do Estado, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro 20221-161, Brazil., Hemmati P; Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, 10117 Berlin, Germany., Araos R; Facultad de Medicina Clínica, Instituto de Ciencias e Innovación en Medicina, Alemana Universidad del Desarrollo, Santiago de Chile, and Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago de Chile 12461, Chile., Peghin M; Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy., Del Pozo JL; Infectious Diseases and Microbiology Unit, Faculty of Medicine, Navarra University Clinic, 31008 Pamplona, Spain., Yáñez L; Haematology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain., Tilley R; Microbiology Department, University Hospitals Plymouth NHS Trust, Plymouth 8DH, UK., Manzur A; Infectious Diseases, Hospital Rawson, San Juan J5400, Argentina., Novo A; Haematology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain., Pallarès N; Statistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, 08908 Tarragona, Spain., Bergas A; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain., Carratalà J; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain., Gudiol C; Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.; Infectious Diseases Unit, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, IDIBELL, 08908 Barcelona, Spain., On Behalf Of The Ironic Study Group
Jazyk: angličtina
Zdroj: Microorganisms [Microorganisms] 2022 Mar 29; Vol. 10 (4). Date of Electronic Publication: 2022 Mar 29.
DOI: 10.3390/microorganisms10040733
Abstrakt: To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006−2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01−2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27−0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76−2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.
Databáze: MEDLINE
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