Puranam Kaushik, Harrington Meagan, Kasonkanji Edwards, Tegha Gerald, Chikasema Maria J, Chawinga Mena L, Chagomerana Maganizo B, Krysiak Robert, Gopal Satish, van Duin David, Miller Melissa B, Painschab Matthew S
Department of Medicine, Duke University, Durham, NC, USA.
University of North Carolina Project-Malawi, Cancer Program, Lilongwe, Malawi.
JAC Antimicrob Resist. 2024 Oct 29;6(5):dlae173. doi: 10.1093/jacamr/dlae173. eCollection 2024 Oct.
To evaluate causes of fever, including resistance patterns, in patients undergoing cancer treatment in Malawi.
In this prospective cohort study, enrolled patients undergoing chemotherapy at Kamuzu Central Hospital in Lilongwe, Malawi were given a thermometer. If a temperature of ≥38°C was recorded, they were instructed to return for hospitalization, standardized fever workup, and antibiotics. All patients were followed through 90 days post-fever event or completion of chemotherapy.
One hundred and five patients were screened and 50 were enrolled. Of the enrollees, 26 (52%) were men and 26 (52%) were HIV positive, with a mean ART duration of 7 years and CD4 count of 293 cells/µL. The most common diagnoses were aggressive non-Hodgkin lymphoma (40%) and Hodgkin lymphoma (22%). Twenty-three febrile events were recorded from 15 patients. Of the 23 events, a causative agent was isolated in 13 cases: (6), (3), (2), (1) and (1). Of the six isolates, all were found to be resistant to fluoroquinolones and 4/6 (66%) were resistant to cephalosporins. All patients but one survived; the death was attributed to bacteraemia.
This study describes laboratory-confirmed causes of neutropenic fever (NF) in cancer patients in Malawi. Gram-negative rods, followed by malaria, were the most common source of infection. Gram-negative rods were associated with high rates of antimicrobial resistance. Malaria and resistant bacterial infections should be considered for NF treatment and prevention in sub-Saharan Africa.
评估马拉维接受癌症治疗患者发热的原因，包括耐药模式。
在这项前瞻性队列研究中，为在马拉维利隆圭的卡穆祖中央医院接受化疗的入选患者发放了体温计。如果记录到体温≥38°C，会指示他们返回医院住院、接受标准化发热检查及使用抗生素。所有患者在发热事件后90天或化疗结束后均接受随访。
筛查了105名患者，50名入选。入选患者中，26名（52%）为男性，26名（52%）为HIV阳性，抗逆转录病毒治疗平均时长为7年，CD4细胞计数为293个/微升。最常见的诊断是侵袭性非霍奇金淋巴瘤（40%）和霍奇金淋巴瘤（22%）。15名患者记录到23次发热事件。在这23次事件中，13例分离出病原体：（6例）、（3例）、（2例）、（1例）和（1例）。在6株分离株中，所有菌株均对氟喹诺酮耐药，4/6（66%）对头孢菌素耐药。除1名患者外所有患者均存活；死亡归因于菌血症。
本研究描述了马拉维癌症患者中性粒细胞减少性发热（NF）经实验室确认的病因。革兰氏阴性杆菌，其次是疟疾，是最常见的感染源。革兰氏阴性杆菌与高耐药率相关。在撒哈拉以南非洲，NF的治疗和预防应考虑疟疾和耐药细菌感染。
