Aetiology, susceptibility and outcomes of fever in patients receiving chemotherapy in Malawi: a prospective study.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-10-29 eCollection Date: 2024-10-01 DOI:10.1093/jacamr/dlae173
Kaushik Puranam, Meagan Harrington, Edwards Kasonkanji, Gerald Tegha, Maria J Chikasema, Mena L Chawinga, Maganizo B Chagomerana, Robert Krysiak, Satish Gopal, David van Duin, Melissa B Miller, Matthew S Painschab
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Abstract

Objectives: To evaluate causes of fever, including resistance patterns, in patients undergoing cancer treatment in Malawi.

Methods: In this prospective cohort study, enrolled patients undergoing chemotherapy at Kamuzu Central Hospital in Lilongwe, Malawi were given a thermometer. If a temperature of ≥38°C was recorded, they were instructed to return for hospitalization, standardized fever workup, and antibiotics. All patients were followed through 90 days post-fever event or completion of chemotherapy.

Results: One hundred and five patients were screened and 50 were enrolled. Of the enrollees, 26 (52%) were men and 26 (52%) were HIV positive, with a mean ART duration of 7 years and CD4 count of 293 cells/µL. The most common diagnoses were aggressive non-Hodgkin lymphoma (40%) and Hodgkin lymphoma (22%). Twenty-three febrile events were recorded from 15 patients. Of the 23 events, a causative agent was isolated in 13 cases: Escherichia coli (6), Plasmodium falciparum (3), Streptococcus pneumoniae (2), Pseudomonas aeruginosa (1) and Citrobacter freundii (1). Of the six E. coli isolates, all were found to be resistant to fluoroquinolones and 4/6 (66%) were resistant to cephalosporins. All patients but one survived; the death was attributed to Pseudomonas bacteraemia.

Conclusions: This study describes laboratory-confirmed causes of neutropenic fever (NF) in cancer patients in Malawi. Gram-negative rods, followed by malaria, were the most common source of infection. Gram-negative rods were associated with high rates of antimicrobial resistance. Malaria and resistant bacterial infections should be considered for NF treatment and prevention in sub-Saharan Africa.

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马拉维化疗患者发热的病因、易感性和结果:一项前瞻性研究。
目的:评估马拉维接受癌症治疗的患者发烧的原因,包括抗药性模式:评估马拉维接受癌症治疗的患者发烧的原因,包括耐药性模式:在这项前瞻性队列研究中,马拉维利隆圭卡穆祖中心医院向接受化疗的登记患者发放了体温计。如果记录到体温≥38°C,则指示他们返回医院接受标准化的发烧检查和抗生素治疗。所有患者在发烧后 90 天或化疗结束后接受随访:结果:共筛查出 155 名患者,其中 50 人被纳入治疗。其中 26 人(52%)为男性,26 人(52%)为 HIV 阳性,平均抗逆转录病毒疗法持续时间为 7 年,CD4 细胞计数为 293 cells/µL。最常见的诊断是侵袭性非霍奇金淋巴瘤(40%)和霍奇金淋巴瘤(22%)。15 名患者共记录到 23 起发热事件。在这 23 起事件中,有 13 例分离出了致病菌:大肠杆菌(6 例)、恶性疟原虫(3 例)、肺炎链球菌(2 例)、铜绿假单胞菌(1 例)和弗氏柠檬杆菌(1 例)。在分离出的 6 株大肠杆菌中,发现所有大肠杆菌都对氟喹诺酮类药物产生耐药性,4/6(66%)对头孢菌素类药物产生耐药性。除一人外,所有患者均存活;死亡原因是假单胞菌菌血症:本研究描述了马拉维癌症患者中性粒细胞减少性发热(NF)的实验室确诊病因。革兰氏阴性杆菌是最常见的感染源,其次是疟疾。革兰氏阴性杆菌对抗生素的耐药性较高。在撒哈拉以南非洲地区,治疗和预防 NF 时应考虑疟疾和耐药细菌感染。
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CiteScore
5.30
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审稿时长
16 weeks
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