Please use this identifier to cite or link to this item:
https://www.arca.fiocruz.br/handle/icict/54622
Type
ArticleCopyright
Open access
Collections
- IOC - Artigos de Periódicos [12512]
Metadata
Show full item record
EFFECT OF COMBINATION ANTIBIOTIC EMPIRICAL THERAPY ON MORTALITY IN NEUTROPENIC CANCER PATIENTS WITH PSEUDOMONAS AERUGINOSA PNEUMONIA
Infecção da corrente sanguínea
Pneumonia
Choque séptico
Neutropenia
Author
Albasanz-Puig, Adaia
Durà-Miralles, Xavier
Laporte-Amargós, Julia
Mussetti, Alberto
Ruiz-Camps, Isabel
Puerta-Alcalde, Pedro
Abdala, Edson
Oltolini, Chiara
Akova, Murat
Montejo, José Miguel
Mikulska, Malgorzata
Martín-Dávila, Pilar
Herrera, Fabián
Gasch, Oriol
Drgona, Lubos
Morales, Hugo Manuel Paz
Brunel, Anne-Sophie
García, Estefanía
Isler, Burcu
Kern, Winfried V.
Retamar-Gentil, Pilar
Aguado, José María
Montero, Milagros
Kanj, Souha S.
Sipahi, Oguz R.
Calik, Sebnem
Márquez-Gómez, Ignacio
Marin, Jorge I.
Gomes, Marisa Z. R.
Hemmati, Philipp
Araos, Rafael
Peghin, Maddalena
del Pozo, José Luis
Yáñez, Lucrecia
Tilley, Robert
Manzur, Adriana
Novo, Andres
Pallarès, Natàlia
Bergas, Alba
Carratalà, Jordi
Gudiol, Carlota
on behalf of the IRONIC Study Group
Durà-Miralles, Xavier
Laporte-Amargós, Julia
Mussetti, Alberto
Ruiz-Camps, Isabel
Puerta-Alcalde, Pedro
Abdala, Edson
Oltolini, Chiara
Akova, Murat
Montejo, José Miguel
Mikulska, Malgorzata
Martín-Dávila, Pilar
Herrera, Fabián
Gasch, Oriol
Drgona, Lubos
Morales, Hugo Manuel Paz
Brunel, Anne-Sophie
García, Estefanía
Isler, Burcu
Kern, Winfried V.
Retamar-Gentil, Pilar
Aguado, José María
Montero, Milagros
Kanj, Souha S.
Sipahi, Oguz R.
Calik, Sebnem
Márquez-Gómez, Ignacio
Marin, Jorge I.
Gomes, Marisa Z. R.
Hemmati, Philipp
Araos, Rafael
Peghin, Maddalena
del Pozo, José Luis
Yáñez, Lucrecia
Tilley, Robert
Manzur, Adriana
Novo, Andres
Pallarès, Natàlia
Bergas, Alba
Carratalà, Jordi
Gudiol, Carlota
on behalf of the IRONIC Study Group
Affilliation
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain / Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain.
Hematology Department, Catalan Institute of Oncology (ICO)-Duran i Reynals Hospital, IDIBELL. Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain.
Infectious Diseases Department, Hospital Clínic i Provincial, 08035 Barcelona, Spain.
Universidade de São Paulo. Faculdade de Medicina. Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brasil.
Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Department of Infectious Diseases, Hacettepe University School of Medicine, 06230 Ankara, Turkey.
Infectious Diseases Department, Cruces University Hospital, 48903 Bilbao, Spain.
Division of Infectious Diseases, Department of Health Sciences, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, 16132 Genoa, Italy.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Department, Ramon y Cajal Hospital, 28034 Madrid, Spain.
Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires. Argentina.
Infectious Diseases Department, Parc Taulí University Hospital, Sabadell, 08208 Barcelona, Spain.
Oncohematology Department, Comenius University and National Cancer Institute. Bratislava, Slovakia.
Hospital Erasto Gaertner. Departamento de Doenças Infecciosas. Curitiba, PR, Brasil.
Infectious Diseases Department, Department of Medicine, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland.
Haematology Department, Reina Sofía University Hospital-IMIBIC-UCO, 14004 Córdoba, Spain.
Department of Infectious Diseases and Clinical Microbiology, Istanbul Education and Research Hospital, Istanbul 34668, Turkey.
Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Center and Faculty of Medicine, 79110 Freiburg, Germany.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Department of Medicine, Universidad de Sevilla, Institute of Biomedicine of Seville, Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, 41013 Seville, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Unit, Instituto de Investigación Hospital “12 de Octubre” (i + 12), “12 de Octubre” University Hospital, School of Medicine, Universidad Complutense, 28041 Madrid, Spain.
Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigations Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
Infectious Diseases Division, American University of Beirut Medical Center, Beirut 110236, Lebanon.
Faculty of Medicine, Ege University, Izmir 35040, Turkey.
Department of Infectious Diseases and Clinical Microbiology, University of Health Science Izmir Bozyaka Training and Research Hospital, Izmir 35170, Turkey.
Infectious Diseases Department, Hospital Regional de Málaga, 29010 Málaga, Spain.
Infectious Diseases and Clinical Microbiology Department, Clínica Maraya, Pereira, Colombia, Critical Care and Clinical Microbiology Department, Manizales 170001-17, Colombia.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil / Ministério da Saúde. Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.
Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, 10117 Berlin, Germany.
Facultad de Medicina Clínica, Instituto de Ciencias e Innovación en Medicina, Alemana Universidad del Desarrollo, Santiago de Chile, and Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago de Chile 12461, Chile.
Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy.
Infectious Diseases and Microbiology Unit, Faculty of Medicine, Navarra University Clinic, 31008 Pamplona, Spain.
Haematology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
Microbiology Department, University Hospitals Plymouth NHS Trust, Plymouth 8DH, UK;.
Infectious Diseases, Hospital Rawson, San Juan J5400, Argentina.
Haematology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain.
Statistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, 08908 Tarragona, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain / Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain / Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Unit, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, IDIBELL, 08908 Barcelona, Spain.
on behalf of the IRONIC Study Group
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain.
Hematology Department, Catalan Institute of Oncology (ICO)-Duran i Reynals Hospital, IDIBELL. Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain.
Infectious Diseases Department, Hospital Clínic i Provincial, 08035 Barcelona, Spain.
Universidade de São Paulo. Faculdade de Medicina. Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brasil.
Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Department of Infectious Diseases, Hacettepe University School of Medicine, 06230 Ankara, Turkey.
Infectious Diseases Department, Cruces University Hospital, 48903 Bilbao, Spain.
Division of Infectious Diseases, Department of Health Sciences, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, 16132 Genoa, Italy.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Department, Ramon y Cajal Hospital, 28034 Madrid, Spain.
Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires. Argentina.
Infectious Diseases Department, Parc Taulí University Hospital, Sabadell, 08208 Barcelona, Spain.
Oncohematology Department, Comenius University and National Cancer Institute. Bratislava, Slovakia.
Hospital Erasto Gaertner. Departamento de Doenças Infecciosas. Curitiba, PR, Brasil.
Infectious Diseases Department, Department of Medicine, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland.
Haematology Department, Reina Sofía University Hospital-IMIBIC-UCO, 14004 Córdoba, Spain.
Department of Infectious Diseases and Clinical Microbiology, Istanbul Education and Research Hospital, Istanbul 34668, Turkey.
Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Center and Faculty of Medicine, 79110 Freiburg, Germany.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Department of Medicine, Universidad de Sevilla, Institute of Biomedicine of Seville, Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, 41013 Seville, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Unit, Instituto de Investigación Hospital “12 de Octubre” (i + 12), “12 de Octubre” University Hospital, School of Medicine, Universidad Complutense, 28041 Madrid, Spain.
Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigations Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
Infectious Diseases Division, American University of Beirut Medical Center, Beirut 110236, Lebanon.
Faculty of Medicine, Ege University, Izmir 35040, Turkey.
Department of Infectious Diseases and Clinical Microbiology, University of Health Science Izmir Bozyaka Training and Research Hospital, Izmir 35170, Turkey.
Infectious Diseases Department, Hospital Regional de Málaga, 29010 Málaga, Spain.
Infectious Diseases and Clinical Microbiology Department, Clínica Maraya, Pereira, Colombia, Critical Care and Clinical Microbiology Department, Manizales 170001-17, Colombia.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil / Ministério da Saúde. Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.
Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, 10117 Berlin, Germany.
Facultad de Medicina Clínica, Instituto de Ciencias e Innovación en Medicina, Alemana Universidad del Desarrollo, Santiago de Chile, and Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago de Chile 12461, Chile.
Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy.
Infectious Diseases and Microbiology Unit, Faculty of Medicine, Navarra University Clinic, 31008 Pamplona, Spain.
Haematology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
Microbiology Department, University Hospitals Plymouth NHS Trust, Plymouth 8DH, UK;.
Infectious Diseases, Hospital Rawson, San Juan J5400, Argentina.
Haematology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain.
Statistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, 08908 Tarragona, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain / Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain.
Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain / Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madri, Spain / Infectious Diseases Unit, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, IDIBELL, 08908 Barcelona, Spain.
on behalf of the IRONIC Study Group
Abstract
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.
Keywords in Portuguese
Pseudomonas aeruginosaInfecção da corrente sanguínea
Pneumonia
Choque séptico
Neutropenia
Share