TY - JOUR
T1 - Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia
AU - Albasanz-Puig, Adaia
AU - Durà-Miralles, Xavier
AU - Laporte-Amargós, Júlia
AU - Mussetti, Alberto
AU - Ruiz-Camps, Isabel
AU - Puerta-Alcalde, Pedro
AU - Abdala, Edson
AU - Oltolini, Chiara
AU - Akova, Murat
AU - Montejo, José Miguel
AU - Mikulska, Malgorzata
AU - Martín-Dávila, Pilar
AU - Herrera, Fabián
AU - Gasch Blasi, Oriol
AU - Drgona, Lubos
AU - Morales, Hugo Manuel Paz
AU - Brunel, Anne-Sophie
AU - García, Estefanía
AU - Isler, Burcu
AU - Kern, Winfried V.
AU - Retamar-Gentil, Pilar
AU - Aguado, José María
AU - Montero, Milagros
AU - Kanj, Souha S.
AU - Sipahi, Oguz R.
AU - Calik, Sebnem
AU - Márquez-Gómez, Ignacio
AU - Marin, Jorge I.
AU - Gomes, Marisa Z. R.
AU - Hemmati, Philipp
AU - Araos, Rafael
AU - Peghin, Maddalena
AU - Del Pozo, Jose Luis
AU - Yáñez, Lucrecia
AU - Tilley, Robert
AU - Manzur, Adriana
AU - Novo, Andres
AU - Pallarès, Natàlia
AU - Bergas, Alba
AU - Carratalà, Jordi
AU - Gudiol, Carlota
PY - 2022
Y1 - 2022
N2 - To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006-2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01-2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27-0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76-2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.
AB - To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006-2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01-2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27-0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76-2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.
KW - Pseudomonas aeruginosa
KW - Bloodstream infection
KW - Neutropenia
KW - Pneumonia
KW - Septic shock
UR - https://www.scopus.com/pages/publications/85127423530
U2 - 10.3390/microorganisms10040733
DO - 10.3390/microorganisms10040733
M3 - Article
C2 - 35456784
SN - 2076-2607
VL - 10
JO - Microorganisms
JF - Microorganisms
ER -
