| Título : |
Association between inappropriate empirical antimicrobial therapy and mortality in gram-negative bloodstream infections in patients with febrile neutropenia and hematological malignancy |
| Tipo de documento : |
documento electrónico |
| Autores : |
Isabel Cristina Ramírez Sánchez, Autor ; Flórez Riaño, Ariel Fernando, Autor ; Rojas Castro, Oscar Julián, Autor ; Ospina, Sigifredo, Autor |
| Fecha de publicación : |
2025 |
| Títulos uniformes : |
Journal of Infection and Chemotherapy
|
| Idioma : |
Español (spa) Idioma original : Inglés (eng) |
| Palabras clave : |
Bloodstream infection; Carbapenem resistance; Empirical treatment; Febrile neutropenia; Gram-negative bacilli; Inappropriate therapy; Mortality |
| Resumen : |
Background and objective: 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. Methods: 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. Results: 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]). Conclusion: 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. © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control |
| Mención de responsabilidad : |
Flórez Riaño, Ariel Fernando, Rojas Castro, Oscar Julián, Ospina, Sigifredo, Ramírez-Sánchez, Isabel Cristina |
| Referencia : |
Revista de Infecciones y Quimioterapia Volumen 31, Número 2 ,Febrero de 2025, 102538 |
| DOI (Digital Object Identifier) : |
10.1016/j.jiac.2024.10.006 |
| PMID : |
39396607 |
| Derechos de uso : |
CC BY-NC-ND |
| En línea : |
https://www.sciencedirect.com/science/article/abs/pii/S1341321X24002794 |
| Enlace permanente : |
https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis |
Association between inappropriate empirical antimicrobial therapy and mortality in gram-negative bloodstream infections in patients with febrile neutropenia and hematological malignancy [documento electrónico] / Isabel Cristina Ramírez Sánchez, Autor ; Flórez Riaño, Ariel Fernando, Autor ; Rojas Castro, Oscar Julián, Autor ; Ospina, Sigifredo, Autor . - 2025. Obra : Journal of Infection and ChemotherapyIdioma : Español ( spa) Idioma original : Inglés ( eng)
| Palabras clave : |
Bloodstream infection; Carbapenem resistance; Empirical treatment; Febrile neutropenia; Gram-negative bacilli; Inappropriate therapy; Mortality |
| Resumen : |
Background and objective: 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. Methods: 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. Results: 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]). Conclusion: 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. © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control |
| Mención de responsabilidad : |
Flórez Riaño, Ariel Fernando, Rojas Castro, Oscar Julián, Ospina, Sigifredo, Ramírez-Sánchez, Isabel Cristina |
| Referencia : |
Revista de Infecciones y Quimioterapia Volumen 31, Número 2 ,Febrero de 2025, 102538 |
| DOI (Digital Object Identifier) : |
10.1016/j.jiac.2024.10.006 |
| PMID : |
39396607 |
| Derechos de uso : |
CC BY-NC-ND |
| En línea : |
https://www.sciencedirect.com/science/article/abs/pii/S1341321X24002794 |
| Enlace permanente : |
https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis |
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