成人急性白血病诱导化疗期间中性粒细胞减少性发热的临床和微生物学特征。

Clinical and Microbiological Characteristics of Febrile Neutropenia During Induction Chemotherapy in Adults With Acute Leukemia.

机构信息

Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Internal Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

出版信息

Cancer Rep (Hoboken). 2024 Aug;7(8):e2129. doi: 10.1002/cnr2.2129.

DOI:10.1002/cnr2.2129

PMID:39158198

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11331495/

Abstract

BACKGROUND

Few studies regarding infectious causes of febrile neutropenia (FN) in Mexico are available.

AIMS

We aimed to describe clinical and microbiological characteristics of FN episodes during induction chemotherapy in adults with acute leukemia.

METHODS AND RESULTS

This retrospective cohort from a Mexican tertiary care center included adults with newly diagnosed acute leukemia between January 2014, and December 2018. Clinical and microbiological characteristics were summarized using descriptive statistics. Univariate analyses for associations between clinical characteristics and FN and/or death were made; logistic regression analysis was performed to assess relationships with FN. Kaplan-Meier survival estimates were modeled for antimicrobial prophylaxis and FN. Ninety-five patients were included. Median age was 28 (IQR 20-43), 49 (52%) were males, and 74 (78%) developed FN (74/95). Among these, 98% had an identified source of infection (73/74) and 65% had >1. Common infections were urinary tract infection (24%), bacterial sinusitis (20%), and bacterial pneumonia (19%). Gram-negatives were the most frequently isolated microorganisms (69%), followed by Gram-positives (21%), and fungi (9%). Antimicrobial prophylaxis was inversely associated with FN (aOR = 0.07, CI 0.008-0.060, p = 0.02). Invasive fungal diseases were associated with 30-day mortality (aOR = 9.46, 95% CI 1.66-54.05).

CONCLUSION

Infections caused 98% of the FN episodes. Gram-negative bacteria are the most common pathogens.

摘要

背景

关于墨西哥发热性中性粒细胞减少症（FN）的感染原因，目前研究较少。

目的

我们旨在描述成人急性白血病诱导化疗期间 FN 发作的临床和微生物学特征。

方法和结果

本研究为墨西哥三级医疗中心的回顾性队列研究，纳入了 2014 年 1 月至 2018 年 12 月期间新诊断为急性白血病的成人患者。使用描述性统计方法总结临床和微生物学特征。对 FN 和/或死亡与临床特征之间的关联进行单因素分析；采用逻辑回归分析评估与 FN 的关系。对抗菌预防和 FN 进行 Kaplan-Meier 生存估计。共纳入 95 例患者。中位年龄为 28（IQR 20-43），49 例（52%）为男性，74 例（78%）发生 FN（74/95）。其中，98%（73/74）有明确的感染源，65%（49/74）有>1 种感染灶。常见感染包括尿路感染（24%）、细菌性鼻窦炎（20%）和细菌性肺炎（19%）。革兰氏阴性菌是最常分离的微生物（69%），其次是革兰氏阳性菌（21%）和真菌（9%）。抗菌预防与 FN 呈负相关（aOR = 0.07，CI 0.008-0.060，p = 0.02）。侵袭性真菌感染与 30 天死亡率相关（aOR = 9.46，95%CI 1.66-54.05）。