Predictive and risk factor analysis for bloodstream infection in high-risk hematological patients with febrile neutropenia: post-hoc analysis from a prospective, large-scale clinical study

• Published in: International journal of hematology 2021-10, Vol.114 (4), p.472-482
• Main Authors: Okamoto, Akinao, Kanda, Yoshinobu, Kimura, Shun-ichi, Oyake, Tatsuo, Tamura, Kazuo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibiotic Prophylaxis; Antiinfectives and antibacterials; Antimicrobial agents; Bacteremia; Blood; Blood cancer; Blood culture; Chemotherapy; Clinical trials; Complications; Dehydration; Factor analysis; Febrile Neutropenia - diagnosis; Febrile Neutropenia - epidemiology; Febrile Neutropenia - etiology; Febrile Neutropenia - prevention & control; Female; Fever; Gram-negative bacteria; Health risks; Hematologic Neoplasms - complications; Hematologic Neoplasms - diagnosis; Hematologic Neoplasms - epidemiology; Hematologic Neoplasms - therapy; Hematology; Humans; Hypotension; Incidence; Infections; Male; Malignancy; Medicine; Medicine & Public Health; Middle Aged; Neutropenia; Oncology; Original Article; Patients; Prophylaxis; Prospective Studies; Recurrence; Risk analysis; Risk Assessment; Risk Factors; Risk groups; Sepsis - diagnosis; Sepsis - epidemiology; Sepsis - etiology; Sepsis - prevention & control; UMIN; UMIN00010411
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-021-03183-x

Objectives Bloodstream infection (BSI) is a frequent complication observed in patients with febrile neutropenia (FN). BSI risk factors and incidence vary depending on chemotherapy types and prophylactic antimicrobial agents. We clarified these issues by post-hoc analysis of a prospective clinical trial cohort for severe FN in hematological malignancy. Methods We performed an intention-to-treat analysis of 413 high-risk patients and 1272 blood culture sets. Results Overall, 356 patients (86.2%) developed FN, and 20.8% had BSI complications. Prophylactic antimicrobials did not prevent complications of FN and BSI, but the incidence of BSIs of Gram-negative (GN) bacteria was lower than in the non-prophylaxis group (23.8% vs. 56.7%). Multinational Association of Supportive Care in Cancer (MASCC) scores  21 were not (41.7% vs. 17.2%). The only significant risk factors were hypotension and dehydration. axillary temperatures were higher in GN-caused BSIs than in Gram-positive-caused BSIs and in patients with negative blood culture results (38.7 °C vs. 38.2 °C vs. 38.0 °C). The higher the fever, the higher the incidence of BSI and GN bacteremia. Conclusions MASCC score and axillary temperature are strong predictors of BSI. Non-administration of prophylactic antimicrobials and GN-caused BSI are correlated. The clinical trial registration number UMIN00010411.