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