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Mucositis-associated bloodstream infections in adult haematology patients with fever during neutropenia: risk factors and the impact of mucositis severity.
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.
Afiliación
  • de Jonge NA; Department of Haematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. ni.dejonge@amsterdamumc.nl.
  • Janssen JJWM; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands. ni.dejonge@amsterdamumc.nl.
  • Ypma P; Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands. ni.dejonge@amsterdamumc.nl.
  • Herbers AHE; Department of Haematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
  • de Kreuk A; Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
  • Vasmel W; Department of Haematology, HAGA Hospital, Els-Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands.
  • van den Ouweland JMW; Department of Haematology and Oncology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, Hertogenbosch, Netherlands.
  • Beeker A; Department of Internal Medicine, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands.
  • Visser O; Department of Internal Medicine, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands.
  • Zweegman S; Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
  • Blijlevens NMA; Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.
  • van Agtmael MA; Department of Medicine, Isala, Dokter Van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
  • Sikkens JJ; Department of Haematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
Support Care Cancer ; 32(9): 579, 2024 Aug 08.
Article en En | MEDLINE | ID: mdl-39115709
ABSTRACT

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 for ≥ 7 days and had fever. MBI-LCBIs were classified according to Centers for Disease Control (CDC) definitions and were followed until the end of 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mucositis / Fiebre / Neutropenia Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Support Care Cancer Asunto de la revista: NEOPLASIAS / SERVICOS DE SAUDE Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mucositis / Fiebre / Neutropenia Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Support Care Cancer Asunto de la revista: NEOPLASIAS / SERVICOS DE SAUDE Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Alemania