Abi Frem Jim, Khazzeka Alicia, Allaw Fatima, Doueiry Caren, Ghoussaini Racha, Mohamad Rayan, Kanafani Zeina A
Brighton and Sussex University Hospitals, Brighton, UK.
American University of Beirut, Cairo Street, Riad El Solh, PO Box 11-0236/11D, Beirut, 1107 2020, Lebanon.
Sci Rep. 2024 Dec 28;14(1):31322. doi: 10.1038/s41598-024-82795-9.
Febrile neutropenia is a major complication in patients with acute leukemia or those undergoing hematopoietic stem cell transplantation (HSCT). Understanding patient characteristics and susceptibility patterns in febrile neutropenia is essential for appropriate antimicrobial therapy. First-line agents should have Pseudomonas aeruginosa coverage, but with the increase in multi-drug resistant organisms, ceftazidime-avibactam has emerged as a new therapeutic option. This retrospective case-control study included 300 admissions (143 patients) between January 2009 and December 2022. Patients with hematologic neoplasms and patients that underwent HSCT, satisfying the criteria of febrile neutropenia and treated with ceftazidime-avibactam (CAZAVI) were included and compared to controls who received the best available therapy (BAT). A bivariate regression model explored independent predictors of septic shock and mortality. Patients who received CAZAVI were more likely to have a microbiologically documented infection (59.0% vs. 28.3%). Complications were significantly more frequent in the CAZAVI group, with sepsis being the most common (59.0%). Multivariable logistic regression analysis showed that receiving CAZAVI was an independent risk factor for both sepsis and mortality (aOR 6.33 [95% CI 2.81-14.30] and 7.82 [2.63-23.26], respectively). Knowing common organisms and patterns of resistance, with an understanding of risk factors for morbidity and mortality, is crucial for the antimicrobial management of febrile neutropenia. Further studies on the effectiveness of CAZAVI in this population are needed.
发热性中性粒细胞减少是急性白血病患者或接受造血干细胞移植（HSCT）患者的主要并发症。了解发热性中性粒细胞减少患者的特征和易感性模式对于适当的抗菌治疗至关重要。一线药物应覆盖铜绿假单胞菌，但随着多重耐药菌的增加，头孢他啶-阿维巴坦已成为一种新的治疗选择。这项回顾性病例对照研究纳入了2009年1月至2022年12月期间的300例住院病例（143例患者）。纳入了血液系统肿瘤患者和接受HSCT且符合发热性中性粒细胞减少标准并接受头孢他啶-阿维巴坦（CAZAVI）治疗的患者，并与接受最佳可用治疗（BAT）的对照组进行比较。双变量回归模型探讨了感染性休克和死亡率的独立预测因素。接受CAZAVI治疗的患者更有可能有微生物学记录的感染（59.0%对28.3%）。CAZAVI组的并发症明显更频繁，败血症是最常见的（59.0%）。多变量逻辑回归分析表明，接受CAZAVI是败血症和死亡率的独立危险因素（分别为aOR 6.33 [95% CI 2.81-14.30]和7.82 [2.63-23.26]）。了解常见病原体和耐药模式，并了解发病和死亡的危险因素，对于发热性中性粒细胞减少的抗菌管理至关重要。需要进一步研究CAZAVI在该人群中的有效性。
