School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China.
Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong, Special Administrative Region of China.
BMC Infect Dis. 2023 Apr 13;23(1):226. doi: 10.1186/s12879-023-08218-8.
Epidemiology of infectious diseases causing febrile illness varies geographically with human attributes. Periodic institutional surveillance of clinical and microbiological profiles in adding data to updating trends, modulating pharmatherapeutics, signifying possible excessive treatments and risk of drug resistance in post-chemotherapy neutropenic fever (NF) in hematological malignancy (HM) is limited. We aimed to review institutional clinical and microbiological data and explore clinical phenotype pattern groups among data.
Available data from 372 NF episodes were included. Demographics, types of malignancies, laboratory data, antimicrobial treatments and febrile-related outcome data such as predominant pathogens and microbiological diagnosed infections (MDIs) were collected. Descriptive statistics, two-step cluster analysis and non-parametric tests were employed.
The occurrences of microbiological diagnosed bacterial infections (MDBIs; 20.2%) and microbiological diagnosed fungal infections (MDFIs; 19.9%) were almost equal. Gram-negative pathogens (11.8%) were comparable with gram-positive pathogens (9.9%), with gram-negative being slightly predominant. Death rate was 7.5%. Two-step cluster analysis yielded four distinct clinical phenotype pattern (cluster) groups: cluster 1 'lymphomas without MDIs', cluster 2 'acute leukemias MDBIs', cluster 3 'acute leukemias MDFIs' and cluster 4 'acute leukemias without MDIs'. Considerable NF events with antibiotic prophylaxis being not identified as MDI might have cases in low-risk with non-infectious reasons causing febrile reactions that might possibly not require prophylaxis.
Regular institutional surveillance with active parameter assessments to signify risk levels in the post-chemotherapy stage, even prior to the onset of fever, might be an evidence-based strategy in the management of NF in HM.
引起发热疾病的传染病的流行病学在地理上因人类特征而异。定期对临床和微生物特征进行机构监测，为更新趋势提供数据，调节药物治疗，表明在血液恶性肿瘤（HM）化疗后中性粒细胞减少性发热（NF）中可能存在过度治疗和耐药风险，这在机构中受到限制。我们旨在回顾机构临床和微生物学数据，并探索数据中的临床表型模式组。
纳入了 372 例 NF 发作的可用数据。收集了人口统计学、恶性肿瘤类型、实验室数据、抗菌治疗以及发热相关结局数据，如主要病原体和微生物学诊断感染（MDIs）。采用描述性统计、两步聚类分析和非参数检验。
微生物学诊断细菌感染（MDBIs；20.2%）和微生物学诊断真菌感染（MDFIs；19.9%）的发生率几乎相等。革兰氏阴性病原体（11.8%）与革兰氏阳性病原体（9.9%）相当，革兰氏阴性略占优势。死亡率为 7.5%。两步聚类分析产生了四个不同的临床表型模式（聚类）组：聚类 1 '无 MDIs 的淋巴瘤'、聚类 2 '急性白血病 MDBIs'、聚类 3 '急性白血病 MDFIs' 和聚类 4 '无 MDIs 的急性白血病'。在化疗后阶段，有相当数量的 NF 事件即使有抗生素预防，但未被识别为 MDIs，这些事件可能是由于非感染性原因引起的低风险发热反应，可能不需要预防。
定期进行机构监测，并积极评估参数，以在化疗后阶段甚至在发热前就提示风险水平，这可能是 HM 中 NF 管理的基于证据的策略。
