期刊
CLINICAL INFECTIOUS DISEASES
卷 70, 期 6, 页码 1068-1074出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciz319
关键词
inappropriate treatment; multidrug resistance; bacteremia; neutropenia; mortality
资金
- Ministerio de Sanidad y Consumo
- Instituto de Salud Carlos III [RH041828]
- European Regional Development Fund
- Merck Sharp and Dohme (MSD) [2018-00020723]
- Catalan Health Agency, PERIS (Pla estrategic de recerca i innovacio en salut [Strategic Plan for Research and Innovation in HealthCare])
- Agency for Management of University [2017SGR1432]
- Catalan Health Agency
Background We aimed to describe the current rates of inappropriate empirical antibiotic treatment (IEAT) in oncohematological patients with febrile neutropenia (FN) and its impact on mortality. Methods This was a multicenter prospective study of all episodes of bloodstream infection (BSI) in high-risk FN patients (2006-2017). Episodes receiving IEAT were compared with episodes receiving appropriate empirical therapy. Adherence to Infectious Diseases Society of America (IDSA) recommendations was evaluated. Multivariate analysis was performed to identify independent risk factors for mortality in Pseudomonas aeruginosa episodes. Results Of 1615 episodes, including Escherichia coli (24%), coagulase-negative staphylococci (21%), and P. aeruginosa (16%), 394 (24%) received IEAT despite IDSA recommendations being followed in 87% of cases. Patients with multidrug-resistant gram-negative bacilli (MDR-GNB), accounting for 221 (14%) of all isolates, were more likely to receive IEAT (39% vs 7%, P < .001). Overall mortality was higher in patients with GNB BSI who received IEAT (36% vs 24%, P = .004); when considering individual microorganisms, only patients with infection caused by P. aeruginosa experienced a significant increase in mortality when receiving IEAT (48% vs 31%, P = .027). Independent risk factors for mortality in PA BSI (odds ratio [95% confidence interval] were IEAT (2.41 [1.19-4.91]), shock at onset (4.62 [2.49-8.56]), and pneumonia (3.01 [1.55-5.83]). Conclusions IEAT is frequent in high-risk patients with FN and BSI, despite high adherence to guidelines. This inappropriate treatment primarily impacts patients with P. aeruginosa-related BSI mortality and in turn is the only modifiable factor to improve outcomes.
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