Division of Hematology, Department of Hematology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Int J Hematol. 2021 Oct;114(4):472-482. doi: 10.1007/s12185-021-03183-x. Epub 2021 Jun 25.
Bloodstream infection (BSI) is a frequent complication observed in patients with febrile neutropenia (FN). BSI risk factors and incidence vary depending on chemotherapy types and prophylactic antimicrobial agents. We clarified these issues by post-hoc analysis of a prospective clinical trial cohort for severe FN in hematological malignancy.
We performed an intention-to-treat analysis of 413 high-risk patients and 1272 blood culture sets.
Overall, 356 patients (86.2%) developed FN, and 20.8% had BSI complications. Prophylactic antimicrobials did not prevent complications of FN and BSI, but the incidence of BSIs of Gram-negative (GN) bacteria was lower than in the non-prophylaxis group (23.8% vs. 56.7%). Multinational Association of Supportive Care in Cancer (MASCC) scores < 20 were significantly correlated with the incidence of BSI, whereas MASCC scores > 21 were not (41.7% vs. 17.2%). The only significant risk factors were hypotension and dehydration. axillary temperatures were higher in GN-caused BSIs than in Gram-positive-caused BSIs and in patients with negative blood culture results (38.7 °C vs. 38.2 °C vs. 38.0 °C). The higher the fever, the higher the incidence of BSI and GN bacteremia.
MASCC score and axillary temperature are strong predictors of BSI. Non-administration of prophylactic antimicrobials and GN-caused BSI are correlated.
UMIN00010411.
血流感染（BSI）是发热性中性粒细胞减少症（FN）患者常见的并发症。BSI 的危险因素和发生率因化疗类型和预防性抗菌药物而异。我们通过对血液恶性肿瘤严重 FN 的前瞻性临床试验队列进行事后分析来阐明这些问题。
我们对 413 名高危患者和 1272 份血培养集进行了意向治疗分析。
总体而言，356 名患者（86.2%）发生 FN，20.8%发生 BSI 并发症。预防性抗菌药物不能预防 FN 和 BSI 的并发症，但革兰氏阴性（GN）细菌的 BSI 发生率低于非预防组（23.8%比 56.7%）。多国支持治疗癌症协会（MASCC）评分<20 与 BSI 的发生率显著相关，而 MASCC 评分>21 则没有（41.7%比 17.2%）。唯一显著的危险因素是低血压和脱水。GN 引起的 BSI 患者的腋温高于革兰氏阳性菌引起的 BSI 患者和血培养阴性的患者（38.7°C 比 38.2°C 比 38.0°C）。体温越高，BSI 和 GN 菌血症的发生率越高。
MASCC 评分和腋温是 BSI 的强预测因子。未使用预防性抗菌药物和 GN 引起的 BSI 相关。
UMIN00010411。
