Clinical and Microbiological Characteristics of Febrile Neutropenia During Induction Chemotherapy in Adults With Acute Leukemia

IF 1.9 Q4 ONCOLOGY Cancer reports Pub Date : 2024-08-19 DOI:10.1002/cnr2.2129

Sandra Rajme-López, Andrea C. Tello-Mercado, Edgar Ortíz-Brizuela, Bernardo A. Martínez-Guerra, Karla M. Tamez-Torres, Carla M. Román-Montes, María F. González-Lara, Alfredo Ponce-de-León

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Abstract

Background

Few studies regarding infectious causes of febrile neutropenia (FN) in Mexico are available.

Aims

We aimed to describe clinical and microbiological characteristics of FN episodes during induction chemotherapy in adults with acute leukemia.

Methods and Results

This retrospective cohort from a Mexican tertiary care center included adults with newly diagnosed acute leukemia between January 2014, and December 2018. Clinical and microbiological characteristics were summarized using descriptive statistics. Univariate analyses for associations between clinical characteristics and FN and/or death were made; logistic regression analysis was performed to assess relationships with FN. Kaplan–Meier survival estimates were modeled for antimicrobial prophylaxis and FN. Ninety-five patients were included. Median age was 28 (IQR 20–43), 49 (52%) were males, and 74 (78%) developed FN (74/95). Among these, 98% had an identified source of infection (73/74) and 65% had >1. Common infections were urinary tract infection (24%), bacterial sinusitis (20%), and bacterial pneumonia (19%). Gram-negatives were the most frequently isolated microorganisms (69%), followed by Gram-positives (21%), and fungi (9%). Antimicrobial prophylaxis was inversely associated with FN (aOR = 0.07, CI 0.008–0.060, p = 0.02). Invasive fungal diseases were associated with 30-day mortality (aOR = 9.46, 95% CI 1.66–54.05).

Conclusion

Infections caused 98% of the FN episodes. Gram-negative bacteria are the most common pathogens.

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急性白血病成人诱导化疗期间发热性中性粒细胞减少症的临床和微生物学特征

背景：墨西哥有关发热性中性粒细胞减少症（FN）感染原因的研究很少：墨西哥有关发热性中性粒细胞减少症（FN）感染原因的研究很少。目的：我们旨在描述急性白血病成人患者在诱导化疗期间FN发作的临床和微生物学特征：该回顾性队列来自墨西哥的一家三级医疗中心，纳入了2014年1月至2018年12月期间新确诊的急性白血病成人患者。采用描述性统计方法总结了临床和微生物学特征。对临床特征与FN和/或死亡之间的关联进行了单变量分析；对与FN的关系进行了逻辑回归分析。对抗菌预防和 FN 的 Kaplan-Meier 生存估计值进行了建模。共纳入 95 名患者。中位年龄为 28 岁（IQR 20-43），49（52%）人为男性，74（78%）人出现 FN（74/95）。其中，98%的患者有明确的感染源（73/74），65%的感染源大于1个。常见感染为尿路感染（24%）、细菌性鼻窦炎（20%）和细菌性肺炎（19%）。最常分离到的微生物是革兰氏阴性菌（69%），其次是革兰氏阳性菌（21%）和真菌（9%）。抗菌药预防与 FN 呈反比关系（aOR = 0.07，CI 0.008-0.060，p = 0.02）。侵袭性真菌疾病与 30 天死亡率相关（aOR = 9.46，95% CI 1.66-54.05）：结论：98%的 FN 病例由感染引起。结论：98%的 FN 病例由感染引起，革兰氏阴性菌是最常见的病原体。

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