Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia
Albasanz-Puig, Adaia (Hospital Universitari de Bellvitge)
Durà-Miralles, Xavier (Hospital Universitari de Bellvitge)
Laporte-Amargós, Júlia (Hospital Universitari de Bellvitge)
Mussetti, Alberto (Hospital Universitari de Bellvitge)
Ruiz-Camps, Isabel (Hospital Universitari Vall d'Hebron)
Puerta-Alcalde, Pedro (Hospital Clínic i Provincial de Barcelona)
Abdala, Edson (Instituto do Câncer do Estado de São Paulo)
Oltolini, Chiara (IRCCS San Raffaele Scientific Institute (Milà, Itàlia))
Akova, Murat (Hacettepe University School of Medicine)
Montejo, José Miguel (Hospital Universitario de Cruces (Barakaldo, País Basc))
Mikulska, Malgorzata (University of Genoa (DISSAL) and Ospedale Policlinico San Martino)
Martín-Dávila, Pilar (Hospital Universitario Ramón y Cajal (Madrid))
Herrera, Fabián (Centro de Educación Médica e Investigaciones Clínicas (CEMIC))
Gasch Blasi, Oriol (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Drgona, Lubos (Comenius University and National Cancer Institute)
Morales, Hugo Manuel Paz (Hospital Erasto Gaertner)
Brunel, Anne-Sophie (Lausanne University Hospital)
García, Estefanía (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Isler, Burcu (Istanbul Education and Research Hospital)
Kern, Winfried V. (University of Freiburg Medical Center)
Retamar-Gentil, Pilar (Universidad de Sevilla)
Aguado, José María (Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12))
Montero, Milagros (Institut Hospital del Mar d'Investigacions Mèdiques)
Kanj, Souha S. (American University of Beirut Medical Center)
Sipahi, Oguz R. (Ege University)
Calik, Sebnem (University of Health Science Izmir Bozyaka Training and Research Hospital)
Márquez-Gómez, Ignacio (Hospital Regional Universitario de Málaga)
Marin, Jorge I. (Clínica Maraya (Pereira, Colòmbia))
Gomes, Marisa Z. R. (Hospital Federal dos Servidores do Estado)
Hemmati, Philipp (Klinikum Ernst von Bergmann)
Araos, Rafael (Alemana Universidad del Desarrollo)
Peghin, Maddalena (University of Udine and Azienda Sanitaria Universitaria Integrata)
Del Pozo, Jose Luis (Clínica Universidad de Navarra)
Yáñez, Lucrecia (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Tilley, Robert (University Hospitals Plymouth NHS Trust (Regne Unit))
Manzur, Adriana (Hospital Rawson)
Novo, Andres (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Pallarès, Natàlia (Hospital Universitari de Bellvitge)
Bergas, Alba (Hospital Universitari de Bellvitge)
Carratalà, Jordi (Hospital Universitari de Bellvitge)
Gudiol, Carlota (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Pseudomonas aeruginosa ; Bloodstream infection ; Neutropenia ; Pneumonia ; Septic shock
Published in:	Microorganisms, Vol. 10 (march 2022) , ISSN 2076-2607

DOI: 10.3390/microorganisms10040733
PMID: 35456784

14 p, 1.0 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles