Albasanz-Puig Adaia, Durà-Miralles Xavier, Laporte-Amargós Júlia, Mussetti Alberto, Ruiz-Camps Isabel, Puerta-Alcalde Pedro, Abdala Edson, Oltolini Chiara, Akova Murat, Montejo José Miguel, Mikulska Malgorzata, Martín-Dávila Pilar, Herrera Fabián, Gasch Oriol, Drgona Lubos, Morales Hugo Manuel Paz, Brunel Anne-Sophie, García Estefanía, Isler Burcu, Kern Winfried V, Retamar-Gentil Pilar, Aguado José María, Montero Milagros, Kanj Souha S, Sipahi Oguz R, Calik Sebnem, Márquez-Gómez Ignacio, Marin Jorge I, Gomes Marisa Z R, Hemmati Philipp, Araos Rafael, Peghin Maddalena, Del Pozo José Luis, Yáñez Lucrecia, Tilley Robert, Manzur Adriana, Novo Andres, Pallarès Natàlia, Bergas Alba, Carratalà Jordi, Gudiol Carlota
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.
Microorganisms. 2022 Mar 29;10(4):733. doi: 10.3390/microorganisms10040733.
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.
评估联合抗生素经验性治疗对铜绿假单胞菌（PA）菌血症性肺炎的中性粒细胞减少癌症患者30天病死率的影响。这是一项针对PA血流感染（BSI）的中性粒细胞减少肿瘤血液学患者的多国回顾性队列研究（2006 - 2018年）。仅在PA菌血症性肺炎患者中评估了适当的经验性联合治疗、适当的单药治疗和不适当的经验性抗生素治疗[IEAT]对30天病死率的影响。在1017例PA BSI发作中，294例（28.9%）的BSI来源为肺炎。其中，52例（17.7%）由多重耐药（MDR）菌株引起，68例（23.1%）接受了IEAT，主要是在感染由MDR菌株引起时[52例中的38例（73.1%）对比242例中的30例（12.4%）；p < 0.001]。PA菌血症性肺炎患者的30天病死率高于其他来源的PA BSI患者（55.1%对比31.4%；p < 0.001）。IEAT与30天病死率增加相关（调整后风险比[aHR] 1.44 [95%置信区间（CI）1.01 - 2.03]；p = 0.042），而使用适当的联合经验性治疗与生存率提高独立相关（aHR 0.46 [95%CI 0.27 - 0.78]；p = 0.004）。适当的经验性单药治疗与总体生存率提高无关（aHR 1.25 [95%CI 0.76 - 2.05]；p = 0.39）。对于怀疑肺炎为感染源的发热性中性粒细胞减少患者，应及时给予联合抗生素经验性治疗。
