Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia
Journal
Microorganisms
ISSN
2076-2607
Date Issued
2022
Author(s)
Adaia Albasanz-Puig
Xavier Durà-Miralles
Júlia Laporte-Amargós
Alberto Mussetti
Isabel Ruiz-Camps
Pedro Puerta-Alcalde
Edson Abdala
Chiara Oltolini
Murat Akova
José Miguel Montejo
Malgorzata Mikulska
Pilar Martín-Dávila
Fabián Herrera
Oriol Gasch
Lubos Drgona
Hugo Manuel Paz Morales
Anne-Sophie Brunel
Estefanía García
Burcu Isler
Winfried V. Kern
Pilar Retamar-Gentil
José María Aguado
Milagros Montero
Souha S. Kanj
Oguz R. Sipahi
Sebnem Calik
Ignacio Márquez-Gómez
Jorge I. Marin
Marisa Z. R. Gomes
Philipp Hemmati
Maddalena Peghin
José Luis del Pozo
Lucrecia Yáñez
Robert Tilley
Adriana Manzur
Andres Novo
Natàlia Pallarès
Alba Bergas
Jordi Carratalà
Carlota Gudiol
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:p>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.</jats:p>
Cite this document
Albasanz-Puig, A., Durà-Miralles, X., Laporte-Amargós, J., Mussetti, A., Ruiz-Camps, I., Puerta-Alcalde, P., Abdala, E., Oltolini, C., Akova, M., Montejo, J. M., Mikulska, M., Martín-Dávila, P., Herrera, F., Gasch, O., Drgona, L., Morales, H. M. P., Brunel, A.-S., García, E., Isler, B., … on behalf of the IRONIC Study Group. (2022). Effect of combination antibiotic empirical therapy on mortality in neutropenic cancer patients with pseudomonas aeruginosa pneumonia. Microorganisms, 10(4), 733. https://doi.org/10.3390/microorganisms10040733
Subjects
infectious-diseases society
;
hematologic malignancies
;
risk-factors
;
bacteremia
;
guidelines
;
monotherapy
;
resistance