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학술저널
저자정보
Alrstom Ali (Department of Infectious Disease Faculty of Medicine. Damascus University Damascus Syria.) Alsuliman Tamim (Service d'Hematologie Clinique et de therapie cellulaire hopital Saint-Antoine AP-HP Sorbonne Unive) Daher Nizar (Department of Infectious Disease ? Faculty of Medicine. Syrian Private University Damascus Universi) Abouharb Raed (Department of Gastroenterology and Hepatology ? Faculty of Medicine. Damascus University Damascus S)
저널정보
대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제53권 제1호
발행연도
2021.1
수록면
63 - 74 (12page)

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Background This paper aimed to inspect factors affecting febrile neutropenia patients with hematologic malignancies. The intestinal colonization rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) was assessed. The rate of subsequent ESBL-E and CRE bacteremia correlated with corresponding bacterial colonization was evaluated. Further, the risk factors for ESBL-E and CRE intestinal colonization were examined. Finally, the impact of rectal swab screening combined with adapted empirical antibiotic therapy on the mortality rate of patients with febrile neutropenia was assessed. Materials and Methods Febrile neutropenia patients underwent rectal swabs and collection of blood culture specimens upon admission. Empirical treatment was subsequently modified according to rectal swab results if necessary. Bacteremia patients were treated according to blood culture results. Explorative forward-stepwise logistic regression analyses were used to identify risk factors for ESBL-E and CRE fecal carriage and mortality. Results In total, 201 rectal swabs and 402 blood samples were collected from 163 patients during 201 febrile neutropenia episodes. Of these episodes, 38 (18.90%) were colonized with ESBL-E and 30 (14.92%) with CRE. Bloodstream infections developed in 29/201 (14.42%) episodes. Only bacteremia episodes caused by Gram-negative bacilli were included in our analysis. The development of Gram-negative-rod bacteremia was observed in eight out of 38 (21.05%) ESBL-E colonized episodes and four out of 30 (13.33%) CRE-colonized episodes. A BSI developed in three out of 38 (7.89%) ESBL-E colonized episodes, and two out of 30 (6.66%) CRE-colonized episodes developed BSI with the respective organism. Multivariate analysis identified previous quinolone use as the only independent risk factor for fecal colonization of multi-drug-resistant (MDR) Enterobacteriaceae (ESBL-E and CRE) (odds ratio, 17.09; 95% confidence interval, 5.29 - 55.18; P <0.0001). No significant association was observed between ESBL-E and CRE carriage and increased risk of developing subsequent bacteremia. No significant differences were detected between groups receiving modified and non-modified treatments in duration of hospitalization or antibiotic therapy (univariate analysis) and 28-day mortality rate (logistic regression). Conclusion Quinolone exposure was a major risk factor for ESBL-E and CRE fecal carriage. Performing rectal swab screening for MDR Enterobacteriaceae and modifying empirical antibiotic therapy accordingly did not improve clinical outcomes of febrile neutropenia patients.
#Febrile neutropenia #Intestinal colonization #Modifying empirical therapy

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참고문헌 (25)

참고문헌 신청
Bodey GP / 1966 / Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia / Ann Intern Med 64:328~340 google schola Blijlevens NM / 2000 / Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview / Bone Marrow Transplant 25:1269~1278 google schola Giannella M / 2014 / Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study / Clin Microbiol Infect 20:1357~1362 google schola Narimatsu H / 2007 / Value of pretransplant screening for colonization of Pseudomonas aeruginosa in reduced-intensity umbilical cord blood transplantation for adult patients / Ann Hematol 86:449~451 google schola Srinivasan A / 2010 / Increasing prevalence of nasal and rectal colonization with methicillin-resistant Staphylococcus aureus in children with cancer / Pediatr Blood Cancer 55:1317~1322 google schola

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