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High-risk febrile neutropenia in Auckland 2003-2004: the influence of the microbiology laboratory on patient treatment and the use of pathogen-specific therapy
Background: International guidelines recommend routine microbiological assessment of patients with febrile neutropenia, but do not recommend a change from broad‐spectrum antibiotic therapy to pathogen‐specific therapy when a clinically relevant organism has been isolated. The aim of the study was to...
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| Published in: | Internal medicine journal 2007-01, Vol.37 (1), p.26-31 |
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| Language: | English |
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| cites | cdi_FETCH-LOGICAL-c4389-1865de22704b631039bf64229e53fe0bfdd07010fc4573a8debbec3eaf2e91a73 |
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| container_title | Internal medicine journal |
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| creator | Ritchie, S. Palmer, S. Ellis-Pegler, R. |
| description | Background: International guidelines recommend routine microbiological assessment of patients with febrile neutropenia, but do not recommend a change from broad‐spectrum antibiotic therapy to pathogen‐specific therapy when a clinically relevant organism has been isolated. The aim of the study was to determine the aetiology of febrile neutropenia in adult haematology patients at Auckland City Hospital, to document the changes in treatment made following isolation of a clinically relevant organism and to assess adverse outcomes in any patient who received pathogen‐specific therapy after a positive culture result.
Methods: The results of all microbiological tests together with antibiotic therapy were recorded from consecutive patients with fever and a neutrophil count |
| doi_str_mv | 10.1111/j.1445-5994.2006.01239.x |
| format | article |
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Methods: The results of all microbiological tests together with antibiotic therapy were recorded from consecutive patients with fever and a neutrophil count <0.5 × 109/L over 1 year beginning in May 2003.
Results: One thousand one hundred and ninety‐six specimens were collected from 81 patients during 116 episodes of febrile neutropenia. A pathogen was isolated from blood cultures in 40 episodes: Gram‐positive cocci accounted for 46% of isolates and Gram‐negative bacilli for 35%. Isolation of a pathogen from blood cultures resulted in a change of treatment in 25 of 40 (62.5%, 95%CI 46–77%) episodes. In 12 of these episodes, antibiotic therapy was optimized to a single pathogen‐specific agent. No adverse events or subsequent changes in antibiotic therapy occurred in any of these 12 patients. Isolation of a pathogen from specimens other than blood seldom led to a change in therapy.
Conclusion: Isolation of a pathogen from blood cultures often allows antibiotic therapy to be simplified to a pathogen‐specific regimen. Further study of this approach is warranted.</description><identifier>ISSN: 1444-0903</identifier><identifier>EISSN: 1445-5994</identifier><identifier>DOI: 10.1111/j.1445-5994.2006.01239.x</identifier><identifier>PMID: 17199841</identifier><language>eng</language><publisher>Melbourne, Australia: Blackwell Publishing Asia</publisher><subject><![CDATA[Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - classification ; Anti-Bacterial Agents - therapeutic use ; Bacteremia - drug therapy ; Bacteremia - epidemiology ; Bacteremia - microbiology ; Bacteria - drug effects ; Bacteria - isolation & purification ; Bacterial Infections - diagnosis ; Bacterial Infections - drug therapy ; Bacterial Infections - epidemiology ; Bacterial Infections - microbiology ; Catheterization - adverse effects ; Cephalosporins - administration & dosage ; Cephalosporins - therapeutic use ; disease management ; Drug Resistance ; Equipment Contamination ; febrile neutropenia ; Fever - etiology ; Gentamicins - administration & dosage ; Gentamicins - therapeutic use ; Hematologic Diseases - complications ; Hematologic Neoplasms - complications ; hospital laboratory ; Hospitals, Urban - statistics & numerical data ; Humans ; Laboratories, Hospital - statistics & numerical data ; Medical Audit ; Microbial Sensitivity Tests ; Neutropenia - diagnosis ; Neutropenia - drug therapy ; Neutropenia - epidemiology ; Neutropenia - etiology ; Neutropenia - microbiology ; New Zealand - epidemiology ; pathogen-specific therapy ; Prospective Studies ; Risk Assessment ; Species Specificity]]></subject><ispartof>Internal medicine journal, 2007-01, Vol.37 (1), p.26-31</ispartof><rights>2007 Royal Australasian College of Physicians</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4389-1865de22704b631039bf64229e53fe0bfdd07010fc4573a8debbec3eaf2e91a73</citedby><cites>FETCH-LOGICAL-c4389-1865de22704b631039bf64229e53fe0bfdd07010fc4573a8debbec3eaf2e91a73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17199841$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ritchie, S.</creatorcontrib><creatorcontrib>Palmer, S.</creatorcontrib><creatorcontrib>Ellis-Pegler, R.</creatorcontrib><title>High-risk febrile neutropenia in Auckland 2003-2004: the influence of the microbiology laboratory on patient treatment and the use of pathogen-specific therapy</title><title>Internal medicine journal</title><addtitle>Intern Med J</addtitle><description>Background: International guidelines recommend routine microbiological assessment of patients with febrile neutropenia, but do not recommend a change from broad‐spectrum antibiotic therapy to pathogen‐specific therapy when a clinically relevant organism has been isolated. The aim of the study was to determine the aetiology of febrile neutropenia in adult haematology patients at Auckland City Hospital, to document the changes in treatment made following isolation of a clinically relevant organism and to assess adverse outcomes in any patient who received pathogen‐specific therapy after a positive culture result.
Methods: The results of all microbiological tests together with antibiotic therapy were recorded from consecutive patients with fever and a neutrophil count <0.5 × 109/L over 1 year beginning in May 2003.
Results: One thousand one hundred and ninety‐six specimens were collected from 81 patients during 116 episodes of febrile neutropenia. A pathogen was isolated from blood cultures in 40 episodes: Gram‐positive cocci accounted for 46% of isolates and Gram‐negative bacilli for 35%. Isolation of a pathogen from blood cultures resulted in a change of treatment in 25 of 40 (62.5%, 95%CI 46–77%) episodes. In 12 of these episodes, antibiotic therapy was optimized to a single pathogen‐specific agent. No adverse events or subsequent changes in antibiotic therapy occurred in any of these 12 patients. Isolation of a pathogen from specimens other than blood seldom led to a change in therapy.
Conclusion: Isolation of a pathogen from blood cultures often allows antibiotic therapy to be simplified to a pathogen‐specific regimen. Further study of this approach is warranted.</description><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - classification</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacteremia - drug therapy</subject><subject>Bacteremia - epidemiology</subject><subject>Bacteremia - microbiology</subject><subject>Bacteria - drug effects</subject><subject>Bacteria - isolation & purification</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - epidemiology</subject><subject>Bacterial Infections - microbiology</subject><subject>Catheterization - adverse effects</subject><subject>Cephalosporins - administration & dosage</subject><subject>Cephalosporins - therapeutic use</subject><subject>disease management</subject><subject>Drug Resistance</subject><subject>Equipment Contamination</subject><subject>febrile neutropenia</subject><subject>Fever - etiology</subject><subject>Gentamicins - administration & dosage</subject><subject>Gentamicins - therapeutic use</subject><subject>Hematologic Diseases - complications</subject><subject>Hematologic Neoplasms - complications</subject><subject>hospital laboratory</subject><subject>Hospitals, Urban - statistics & numerical data</subject><subject>Humans</subject><subject>Laboratories, Hospital - statistics & numerical data</subject><subject>Medical Audit</subject><subject>Microbial Sensitivity Tests</subject><subject>Neutropenia - diagnosis</subject><subject>Neutropenia - drug therapy</subject><subject>Neutropenia - epidemiology</subject><subject>Neutropenia - etiology</subject><subject>Neutropenia - microbiology</subject><subject>New Zealand - epidemiology</subject><subject>pathogen-specific therapy</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Species Specificity</subject><issn>1444-0903</issn><issn>1445-5994</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNqNkc1u1DAUhSMEoqX0FZBXiE2CHTs_RmJRVTAtGqCLVpW6sZzkesYzSZzaiZg8TV-19syo7BBe2Fe-5ztX9okiRHBC_Pq8SQhjWZxxzpIU4zzBJKU82b2KTl8ar_c1izHH9CR659wGY1JQzt5GJ6QgnJeMnEZPV3q1jq12W6SgsroF1MM0WjNAryXSPbqY6m0r-wb5QTT2G_uCxjX4lmon6GtARu0vOl1bU2nTmtWMWlkZK0djZ2R6NMhRQz-i0YIcu1AFwwBNbs97wdqsoI_dALVWug5NK4f5ffRGydbB-fE8i-6-f7u9vIqXvxfXlxfLuGa05DEp86yBNC0wq3JKMOWVylmacsioAlyppsEFJljVLCuoLBuoKqgpSJUCJ7KgZ9HHg-9gzeMEbhSddjW0_uVgJify0v8cwcQLP_1TSEpc5gSXJHiWB6n_F-csKDFY3Uk7C4JFyFFsRIhLhLhEyFHscxQ7j344TpmqDpq_4DE4L_h6EPzxkc3_bSyuf_4IlefjA6_dCLsXXtqtyAtaZOL-10I85DfLh8XNQuT0GWZfvLc</recordid><startdate>200701</startdate><enddate>200701</enddate><creator>Ritchie, S.</creator><creator>Palmer, S.</creator><creator>Ellis-Pegler, R.</creator><general>Blackwell Publishing Asia</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200701</creationdate><title>High-risk febrile neutropenia in Auckland 2003-2004: the influence of the microbiology laboratory on patient treatment and the use of pathogen-specific therapy</title><author>Ritchie, S. ; Palmer, S. ; Ellis-Pegler, R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4389-1865de22704b631039bf64229e53fe0bfdd07010fc4573a8debbec3eaf2e91a73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - classification</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacteremia - drug therapy</topic><topic>Bacteremia - epidemiology</topic><topic>Bacteremia - microbiology</topic><topic>Bacteria - drug effects</topic><topic>Bacteria - isolation & purification</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - epidemiology</topic><topic>Bacterial Infections - microbiology</topic><topic>Catheterization - adverse effects</topic><topic>Cephalosporins - administration & dosage</topic><topic>Cephalosporins - therapeutic use</topic><topic>disease management</topic><topic>Drug Resistance</topic><topic>Equipment Contamination</topic><topic>febrile neutropenia</topic><topic>Fever - etiology</topic><topic>Gentamicins - administration & dosage</topic><topic>Gentamicins - therapeutic use</topic><topic>Hematologic Diseases - complications</topic><topic>Hematologic Neoplasms - complications</topic><topic>hospital laboratory</topic><topic>Hospitals, Urban - statistics & numerical data</topic><topic>Humans</topic><topic>Laboratories, Hospital - statistics & numerical data</topic><topic>Medical Audit</topic><topic>Microbial Sensitivity Tests</topic><topic>Neutropenia - diagnosis</topic><topic>Neutropenia - drug therapy</topic><topic>Neutropenia - epidemiology</topic><topic>Neutropenia - etiology</topic><topic>Neutropenia - microbiology</topic><topic>New Zealand - epidemiology</topic><topic>pathogen-specific therapy</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Species Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ritchie, S.</creatorcontrib><creatorcontrib>Palmer, S.</creatorcontrib><creatorcontrib>Ellis-Pegler, R.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Internal medicine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ritchie, S.</au><au>Palmer, S.</au><au>Ellis-Pegler, R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-risk febrile neutropenia in Auckland 2003-2004: the influence of the microbiology laboratory on patient treatment and the use of pathogen-specific therapy</atitle><jtitle>Internal medicine journal</jtitle><addtitle>Intern Med J</addtitle><date>2007-01</date><risdate>2007</risdate><volume>37</volume><issue>1</issue><spage>26</spage><epage>31</epage><pages>26-31</pages><issn>1444-0903</issn><eissn>1445-5994</eissn><abstract>Background: International guidelines recommend routine microbiological assessment of patients with febrile neutropenia, but do not recommend a change from broad‐spectrum antibiotic therapy to pathogen‐specific therapy when a clinically relevant organism has been isolated. The aim of the study was to determine the aetiology of febrile neutropenia in adult haematology patients at Auckland City Hospital, to document the changes in treatment made following isolation of a clinically relevant organism and to assess adverse outcomes in any patient who received pathogen‐specific therapy after a positive culture result.
Methods: The results of all microbiological tests together with antibiotic therapy were recorded from consecutive patients with fever and a neutrophil count <0.5 × 109/L over 1 year beginning in May 2003.
Results: One thousand one hundred and ninety‐six specimens were collected from 81 patients during 116 episodes of febrile neutropenia. A pathogen was isolated from blood cultures in 40 episodes: Gram‐positive cocci accounted for 46% of isolates and Gram‐negative bacilli for 35%. Isolation of a pathogen from blood cultures resulted in a change of treatment in 25 of 40 (62.5%, 95%CI 46–77%) episodes. In 12 of these episodes, antibiotic therapy was optimized to a single pathogen‐specific agent. No adverse events or subsequent changes in antibiotic therapy occurred in any of these 12 patients. Isolation of a pathogen from specimens other than blood seldom led to a change in therapy.
Conclusion: Isolation of a pathogen from blood cultures often allows antibiotic therapy to be simplified to a pathogen‐specific regimen. Further study of this approach is warranted.</abstract><cop>Melbourne, Australia</cop><pub>Blackwell Publishing Asia</pub><pmid>17199841</pmid><doi>10.1111/j.1445-5994.2006.01239.x</doi><tpages>6</tpages></addata></record> |
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| identifier | ISSN: 1444-0903 |
| ispartof | Internal medicine journal, 2007-01, Vol.37 (1), p.26-31 |
| issn | 1444-0903 1445-5994 |
| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - classification Anti-Bacterial Agents - therapeutic use Bacteremia - drug therapy Bacteremia - epidemiology Bacteremia - microbiology Bacteria - drug effects Bacteria - isolation & purification Bacterial Infections - diagnosis Bacterial Infections - drug therapy Bacterial Infections - epidemiology Bacterial Infections - microbiology Catheterization - adverse effects Cephalosporins - administration & dosage Cephalosporins - therapeutic use disease management Drug Resistance Equipment Contamination febrile neutropenia Fever - etiology Gentamicins - administration & dosage Gentamicins - therapeutic use Hematologic Diseases - complications Hematologic Neoplasms - complications hospital laboratory Hospitals, Urban - statistics & numerical data Humans Laboratories, Hospital - statistics & numerical data Medical Audit Microbial Sensitivity Tests Neutropenia - diagnosis Neutropenia - drug therapy Neutropenia - epidemiology Neutropenia - etiology Neutropenia - microbiology New Zealand - epidemiology pathogen-specific therapy Prospective Studies Risk Assessment Species Specificity |
| title | High-risk febrile neutropenia in Auckland 2003-2004: the influence of the microbiology laboratory on patient treatment and the use of pathogen-specific therapy |
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