Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID–IRI study

Erdem H. Kocoglu E. Ankarali H. El-Sokkary R. Hakamifard A. Karaali R. Kulzhanova S. El-Kholy A. Tehrani H.A. Khedr R. Kaya-Kalem A. Pandak N. Cagla-Sonmezer M. Nizamuddin S. Berk-Cam H. Guner R. Elkholy J.A. Llopis F. Marino A. Stebel R. Szabo B.G. Belitova M. Fadel E. Yetisyigit T. Cag Y. Alkan S. Kayaaslan B. Oncu S. Ozdemir M. Yilmaz M. Isik A.C. Başkol D. Sincan G. Cascio A. Ozer-Balin S. Korkmaz N. Ripon R.K. Abbas S. Dumitru I.M. Eser-Karlidag G. Lanzafame M. Rafey A. Raza A. Sipahi O.R. Darazam I.A. Elbahr U. Erdem I. Ergen P. Bilir C. Caskurlu H. Erdem A. Makek M.J. Altindis M. Lakatos B. Luca C.M. Yilmaz E.M. Nsutebu E. Cakmak R. Sirmatel F.
September 2023 Elsevier B.V.

International Journal of Antimicrobial Agents
2023 #62 Issue 3

Objectives: Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. Methods: The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases–International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). Results: A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002–1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120–3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011–3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437–5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368–92.720), and advancing age (OR, 1.017; 95% CI, 1.001–1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. Conclusions: Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.

Antibiotic stewardship , Antimicrobial , Bacteraemia , Febrile neutropenia , Resistance

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Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain
Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
Department of Microbiology and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Infectious Diseases and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Infectious Diseases & Clinical Microbiology, Cerrahpaşa School of Medicine, Istanbul, Turkey
Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
Department of Haematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Paediatric Oncology, National Cancer Institute–Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
The Royal Hospital, Muscat, Oman
Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Turkey
Section of Microbiology, Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Research Hospital, Antalya, Turkey
Department of Anaesthesia, Pain Management, Cairo University Hospital, Cairo, Egypt
Emergency Department, Bellvitge University Hospital, lHospitalet de Llobregat, Barcelona, Spain
Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic
South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
Medical University–Sofia, Department of Anaesthesiology and Intensive Care, University Hospital ‘Queen Giovanna’ ISUL, EAD, Sofia, Bulgaria
Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
Department of Medical Microbiology, Necmettin Erbakan University, Konya, Turkey
Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
Department of Internal Medicine, Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
Department of Haematology, School of Medicine, Ataturk University, Erzurum, Turkey
Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Infectious Disease Unit, Policlinico ‘P. Giaccone’, University of Palermo, Italy
Department of Infectious Diseases and Clinical Microbiology, Firat University, School of Medicine, Elazig, Turkey
Department of Infectious Diseases and Clinical Microbiology, Diskapi Yıldirim Beyazit Education and Research Hospital, Ankara, Turkey
Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Savar, Bangladesh
Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
Clinical Infectious Diseases Hospital Constanta, Ovidius University of Constanta, Romania
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
S.Maria Della Misericordia Hospital, Rovigo, Italy
Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Namık Kemal University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Tekirdağ, Turkey
Department of Oncology, Istinye University, VMMedical Park Pendik Hospital, Istanbul, Turkey
Sakarya University Faculty of Medicine Department of Medical Oncology, Sakarya, Turkey
Department of Pathology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Abant Izzet Baysal University, Bolu, Turkey

Department of Infectious Diseases
Department of Infectious Diseases & Clinical Microbiology
Department of Microbiology and Clinical Microbiology
Department of Biostatistics and Medical Informatics
Department of Medical Microbiology and Immunology
Infectious Diseases and Tropical Medicine Research Centre
Department of Infectious Diseases
Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases
Department of Clinical Pathology
Department of Haematology and Medical Oncology
Department of Paediatric Oncology
Department of Infectious Diseases & Clinical Microbiology
The Royal Hospital
Department of Infectious Diseases & Clinical Microbiology
Section of Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Anaesthesia
Emergency Department
Department of Clinical and Experimental Medicine
Department of Infectious Diseases
South Pest Central Hospital
Medical University–Sofia
Department of Oncology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Medical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Internal Medicine
Department of Infectious Diseases & Clinical Microbiology
Department of Haematology
Department of Health Promotion Sciences
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Department of Public Health and Informatics
Department of Medicine
Clinical Infectious Diseases Hospital Constanta
Department of Infectious Diseases and Clinical Microbiology
S.Maria Della Misericordia Hospital
Infectious Diseases and Tropical Medicine
Namık Kemal University
Department of Oncology
Sakarya University Faculty of Medicine Department of Medical Oncology
Department of Pathology
University of Zagreb School of Medicine
Department of Microbiology
St. Parascheva Clinical Hospital of Infectious Diseases
Department of Infectious Diseases & Clinical Microbiology
Tropical and Infectious Diseases Division
Department of Infectious Diseases & Clinical Microbiology

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