Flórez Riaño Ariel Fernando, Rojas Castro Oscar Julián, Ospina Sigifredo, Ramírez-Sánchez Isabel Cristina
Fellowship Infectious Diseases, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
Clinical Epidemiology, Facultad de Medicina Universidad de Antioquia, Medellín, Colombia.
J Infect Chemother. 2025 Feb;31(2):102538. doi: 10.1016/j.jiac.2024.10.006. Epub 2024 Oct 11.
Inappropriate initial antimicrobial therapy has been associated with high mortality in patients with gram-negative bacilli bloodstream infections during febrile neutropenia following chemotherapy for hematological malignancies. The aim of this study is to determine this association in our hospital.
A single center, retrospective, cohort study of bloodstream infection due to gram-negative bacilli and febrile neutropenia was conducted. Clinical characteristics, microbiological etiology, antimicrobial resistance profile, empirical and targeted antibiotic therapy, intensive care unit admission, persistent bacteremia and mortality were analyzed.
Of the 171 episodes of bloodstream infection due to gram-negative bacilli, empirical antimicrobial therapy was inappropriate in 43 episodes (25.1 %). There was a significant difference in mortality at 7 and 30 days between patients who received appropriate versus inappropriate empirical treatment (4.6 % versus 13.9 %, p = 0.04; 15.6 % versus 32.5 %, p = 0.016). Inappropriate empirical treatment (RR, 2.97 [95 % CI, 1.01-8.74]), shock at the time of febrile neutropenia diagnosis (RR, 6.5 [95 % CI, 1.83-23.05]) carbapenem-resistant microorganism (RR, 3.73 [95 % CI, 1.14-12.24]) and persistent bacteremia (RR, 84.6 [95 % CI, 11.3-629.4]) were associated with an increased mortality at 7 and 30 days. In the multivariate analysis, shock (RR, 4.85 [95 % CI, 2.10-11.65]) was independently associated with increased 30-day mortality, but inappropriate empirical antimicrobial therapy was not an independent prognostic determinant (RR, 1.66 [0.53-4.82]).
Shock at the time of febrile neutropenia diagnosis contributes to mortality in patients with gram-negative bacilli bloodstream infection, in this scenario, appropriate empirical antimicrobial therapy should be encouraged.
在血液系统恶性肿瘤化疗后发热性中性粒细胞减少期间，革兰氏阴性杆菌血流感染患者初始抗菌治疗不当与高死亡率相关。本研究的目的是确定我院的这种关联。
开展了一项关于革兰氏阴性杆菌所致血流感染和发热性中性粒细胞减少的单中心回顾性队列研究。分析了临床特征、微生物病因、抗菌药物耐药情况、经验性和针对性抗生素治疗、重症监护病房入住情况、持续性菌血症和死亡率。
在171例革兰氏阴性杆菌血流感染病例中，43例（25.1%）经验性抗菌治疗不当。接受恰当与不恰当经验性治疗的患者在7天和30天时的死亡率存在显著差异（4.6%对13.9%，p = 0.04；15.6%对32.5%，p = 0.016）。不恰当的经验性治疗（相对危险度，2.97 [95%可信区间，1.01 - 8.74]）、发热性中性粒细胞减少诊断时的休克（相对危险度，6.5 [95%可信区间，1.83 - 23.05]）、耐碳青霉烯类微生物（相对危险度，3.73 [95%可信区间，1.14 - 12.24]）和持续性菌血症（相对危险度，84.6 [95%可信区间，11.3 - 629.4]）与7天和30天时死亡率增加相关。在多变量分析中，休克（相对危险度，4.85 [95%可信区间，2.10 - 11.65]）与30天死亡率增加独立相关，但不恰当的经验性抗菌治疗不是独立的预后决定因素（相对危险度，1.66 [0.53 - 4.82]）。
发热性中性粒细胞减少诊断时的休克导致革兰氏阴性杆菌血流感染患者死亡，在这种情况下，应鼓励进行恰当的经验性抗菌治疗。
