Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia



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Albasanz Puig, Adaia and Durà Miralles, Xavier and Laporte Amargós, Júlia and Mussetti, Alberto and Ruiz Camps, Isabel and Puerta Alcalde, Pedro and Abdala, Edson and Oltolini, Chiara and Akova, Murat and Montejo, José Miguel and Mikulska, Malgorzata and Martín Dávila, Pilar and Herrera, Fabián and Gasch, Oriol and Drgona, Lubos and Morales, Hugo Manuel Paz and Brunel, Anne-Sophie and García, Estefanía and Isler, Burcu and Kern, Winfried V. and Retamar Gentil, Pilar and Aguado García, José María and Montero, Milagros and Kanj, Souha S. and Sipahi, Oguz R. and Calik, Sebnem and Márquez Gómez, Ignacio and Marin, Jorge I. and Gomes, Marisa Z. R. and Hemmati, Philipp and Araos, Rafael and Peghin, Maddalena and Pozo, José Luis del and Yáñez, Lucrecia and Tilley, Robert and Manzur, Adriana and Novo, Andres and Pallarès, Natàlia and Bergas, Alba and Carratalà, Jordi and Gudiol, Carlota (2022) Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia. Microorganisms, 10 (4). p. 733. ISSN 2076-2607

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Official URL: https://doi.org/10.3390/microorganisms10040733


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.

Item Type:Article
Uncontrolled Keywords:Pseudomonas aeruginosa; bloodstream infection; pneumonia; septic shock; neutropenia
Subjects:Medical sciences > Medicine > Oncology
ID Code:75116
Deposited On:19 Oct 2022 10:46
Last Modified:19 Oct 2022 12:10

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