Mucositis-associated bloodstream infections in adult haematology patients with fever during neutropenia: risk factors and the impact of mucositis severity

• Published in: Supportive care in cancer 2024-09, Vol.32 (9), p.579, Article 579
• Main Authors: de Jonge, Nick A., Janssen, Jeroen J. W. M., Ypma, Paula, Herbers, Alexandra H. E., de Kreuk, Arne, Vasmel, Wies, van den Ouweland, Jody M. W., Beeker, Aart, Visser, Otto, Zweegman, Sonja, Blijlevens, Nicole M. A., van Agtmael, Michiel A., Sikkens, Jonne J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Candidemia - epidemiology; Candidemia - etiology; Chemotherapy; Female; Fever; Fever - etiology; Hematologic Neoplasms - complications; Hematology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mucositis; Mucositis - etiology; Netherlands; Neutropenia; Neutropenia - complications; Neutropenia - etiology; Nursing; Nursing Research; Oncology; Pain Medicine; Prospective Studies; Rehabilitation Medicine; Risk Factors; Severity of Illness Index
• ISSN: 0941-4355; 1433-7339; 1433-7339
• DOI: 10.1007/s00520-024-08776-w

Purpose Haematology patients with high-risk neutropenia are prone to mucosal-barrier injury-associated laboratory-confirmed bloodstream infections (MBI-LCBI). We assessed risk factors for MBI-LCBI including candidaemia in neutropenic haematology patients with fever. Methods This prospective observational study was performed in six dedicated haematology units in the Netherlands. Eligible haematology patients had neutropenia  500/mL or discharge. Results We included 416 patients from December 2014 until August 2019. We observed 63 MBI-LCBIs. Neither clinical mucositis scores nor the blood level of citrulline at fever onset was associated with MBI-LCBI. In the multivariable analysis, MASCC-score (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05 to 1.29 per point decrease), intensive chemotherapy (OR 3·81, 95% CI 2.10 to 6.90) and Pichia kudriavzevii (formerly Candida krusei ) colonisation (OR 5.40, 95% CI 1.75 to 16.7) were retained as risk factors for MBI-LCBI, while quinolone use seemed protective (OR 0.42, 95% CI 0.20 to 0.92). Citrulline level (OR 1.57, 95% CI 1.07 to 2.31 per µmol/L decrease), active chronic obstructive pulmonary disease (OR 15.4, 95% CI 1.61 to 14.7) and colonisation with fluconazole-resistant Candida (OR 8.54, 95% CI 1.51 to 48.4) were associated with candidaemia. Conclusion In haematology patients with fever during neutropenia, hypocitrullinaemia at fever onset was associated with candidaemia, but not with bacterial MBI-LCBI. Patients with intensive chemotherapy with a low MASCC-score and colonisation with Pichia kudriavzevii had the highest risk of MBI-LCBI. Trial registration ClinicalTrials.gov (NCT02149329) at 19-NOV-2014.