Hata Natsumi, Ihara Takateru
Division of Emergency Medicine Hyogo Prefectural Amagasaki General Medical Center Hyogo Japan.
Department of Pediatrics Hyogo Prefectural Amagasaki General Medical Center Hyogo Japan.
Acute Med Surg. 2024 Nov 6;11(1):e70012. doi: 10.1002/ams2.70012. eCollection 2024 Jan-Dec.
Febrile neutropenia (FN) is treated by a broad-spectrum antimicrobial. Subsequent antimicrobial therapy depends on identifying the source of the infection. Although urinary tract infections (UTIs) are common and urine culture (UC) is a valuable diagnostic tool, uncertainties remain about the specific indications for conducting UC in FN. This study examined whether performing routine UC would affect the subsequent antimicrobial therapy in FN.
All emergency department patients who received chemotherapy for malignancy and met the definition of FN (neutrophil count <0.5 × 10/L and fever >37.5°C) were included. The patient's demographic data, clinical symptoms, urinalysis results, urine and blood culture results, antibiotic therapy and duration, and patient outcomes were extracted from electronic medical records. UC was defined as positive if >10 colony-forming units/L were detected.
In total, 115 of the initial 124 cases were included in the analysis. Thirty-one cases met the Infectious Diseases Society of America guideline definition for recommending UC (recommended group) and 84 cases did not (non-recommended group). In the recommended group, 16 of 31 cases had a positive UC, and antibiotics were changed for nine, based on UC results. In the non-recommended group, 15 of 84 cases had a positive UC, and antibiotics were changed for two. The same organism were identified in blood cultures. Seven of 115 cases were detected for the same pathogen in blood and urine cultures.
Performing UC regardless of symptoms could diagnose several asymptomatic UTIs in FN, but seldom impact an antimicrobial treatment strategy.
发热性中性粒细胞减少症（FN）采用广谱抗菌药物治疗。后续抗菌治疗取决于确定感染源。虽然尿路感染（UTI）很常见，且尿培养（UC）是一种有价值的诊断工具，但对于在FN中进行UC的具体指征仍存在不确定性。本研究探讨了进行常规UC是否会影响FN的后续抗菌治疗。
纳入所有在急诊科接受恶性肿瘤化疗且符合FN定义（中性粒细胞计数<0.5×10⁹/L且发热>37.5°C）的患者。从电子病历中提取患者的人口统计学数据、临床症状、尿液分析结果、尿液和血液培养结果、抗生素治疗及持续时间以及患者结局。若检测到>10个菌落形成单位/L，则UC定义为阳性。
最初的124例病例中，共有115例纳入分析。31例符合美国传染病学会推荐UC的指南定义（推荐组），84例不符合（非推荐组）。在推荐组中，31例中有16例UC阳性，基于UC结果，9例更换了抗生素。在非推荐组中，84例中有15例UC阳性，2例更换了抗生素。血液培养中鉴定出相同的病原体。115例中有7例在血液和尿液培养中检测到相同病原体。
无论有无症状进行UC均可诊断FN中的一些无症状UTI，但很少影响抗菌治疗策略。
