16 results on '"Albasanz-Puig A"'
Search Results
2. Impact of Empirical Antibiotic Regimens on Mortality in Neutropenic Patients with Bloodstream Infection Presenting with Septic Shock.
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Chumbita M, Puerta-Alcalde P, Gudiol C, Garcia-Pouton N, Laporte-Amargós J, Ladino A, Albasanz-Puig A, Helguera C, Bergas A, Grafia I, Sastre E, Suárez-Lledó M, Durà X, Jordán C, Marco F, Condom M, Castro P, Martínez JA, Mensa J, Soriano A, Carratalà J, and Garcia-Vidal C
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Humans, Prospective Studies, Retrospective Studies, Bacteremia drug therapy, Sepsis drug therapy, Shock, Septic drug therapy
- Abstract
We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. A multicenter retrospective study (2010 to 2019) of two prospective cohorts compared BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Of 1,563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% versus 15%, P < 0.001). Gram-negative bacilli caused 81% of episodes with septic shock, Gram-positive cocci caused 22%, and Candida species caused 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific Gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% versus 51%, P = 0.002). Age of >70 years (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2 to 4.7), IEAT for Candida spp. or Gram-negative bacilli (OR, 3.8; 95% CI, 1.3 to 11.1), acute kidney injury (OR, 2.6; 95% CI, 1.4 to 4.9), and amikacin as the only active antibiotic (OR, 15.2; 95% CI, 1.7 to 134.5) were independent risk factors for mortality, while the combination of β-lactam and amikacin was protective (OR, 0.32; 95% CI, 0.18 to 0.57). Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.
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- 2022
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3. Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study).
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Albasanz-Puig A, Gudiol C, Puerta-Alcalde P, Ayaz CM, Machado M, Herrera F, Martín-Dávila P, Laporte-Amargós J, Cardozo C, Akova M, Álvarez-Uría A, Torres D, Fortún J, García-Vidal C, Muñoz P, Bergas A, Pomares H, Mercadal S, Durà-Miralles X, García-Lerma E, Pallarès N, and Carratalà J
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- Aminoglycosides therapeutic use, Anti-Bacterial Agents therapeutic use, Cohort Studies, Drug Therapy, Combination, Humans, Retrospective Studies, Bacteremia drug therapy, Gram-Negative Bacterial Infections drug therapy, Sepsis drug therapy
- Abstract
To test the hypothesis that the addition of an aminoglycoside to a β-lactam antibiotic could provide better outcomes than β-lactam monotherapy for the initial empirical treatment of hematological neutropenic patients with subsequently documented Gram-negative bacillus (GNB) bloodstream infection (BSI), a multinational, retrospective, cohort study of GNB BSI episodes in hematological neutropenic patients in six centers (2010 to 2017) was conducted. Combination therapy (β-lactam plus aminoglycoside) was compared to β-lactam monotherapy. The primary endpoint was the case fatality rate, assessed at 7 and 30 days from BSI onset. Secondary endpoints were nephrotoxicity and persistent BSI. Propensity score (PS) matching was performed. Among 542 GNB BSI episodes, 304 (56%) were initially treated with combination therapy, with cefepime plus amikacin being most common (158/304 [52%]). Overall, Escherichia coli (273/304 [50.4%]) was the main etiological agent, followed by Pseudomonas aeruginosa, which predominated in the combination group (76/304 [25%] versus 28/238 [11.8%]; P < 0.001). Multidrug resistance rates were similar between groups (83/294 [28.2%] versus 63/233 [27%]; P = 0.95). In the multivariate analysis, combination therapy was associated with a lower 7-day case fatality rate (odds ratio [OR], 0.37; 95% CI, 0.14 to 0.91; P = 0.035) with a tendency toward lower mortality at 30 days (OR, 0.56; 95% CI, 0.29 to 1.08; P = 0.084). After PS matching, these differences remained for the 7-day case fatality rate (OR, 0.33; 95% CI, 0.13 to 0.82; P = 0.017). In addition, aminoglycoside use was not significantly associated with renal function impairment (OR, 1.12; 95% CI, 0.26 to 4.87; P = 0.9). The addition of an aminoglycoside to the initial empirical therapy regimen for febrile neutropenic hematological patients should be considered.
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- 2021
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4. Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa.
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Gudiol C, Albasanz-Puig A, Laporte-Amargós J, Pallarès N, Mussetti A, Ruiz-Camps I, Puerta-Alcalde P, Abdala E, Oltolini C, Akova M, Montejo M, Mikulska M, Martín-Dávila P, Herrera F, Gasch O, Drgona L, Paz Morales H, Brunel AS, García E, Isler B, Kern WV, Morales I, Maestro-de la Calle G, Montero M, Kanj SS, Sipahi OR, Calik S, Márquez-Gómez I, Marin JI, Gomes MZR, Hemmatti P, Araos R, Peghin M, Del Pozo JL, Yáñez L, Tilley R, Manzur A, Novo A, and Carratalà J
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- Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Models, Biological, Neoplasms complications, Neutropenia complications, Pseudomonas Infections drug therapy, Pseudomonas aeruginosa drug effects, ROC Curve, Retrospective Studies, Risk Factors, Treatment Outcome, Bacteremia microbiology, Drug Resistance, Multiple, Bacterial, Neoplasms microbiology, Neutropenia microbiology, Pseudomonas Infections microbiology
- Abstract
We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. Of a total of 1,217 episodes of BSI due to P. aeruginosa , 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period ( P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR], 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development., (Copyright © 2020 American Society for Microbiology.)
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- 2020
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5. Inappropriate Empirical Antibiotic Treatment in High-risk Neutropenic Patients With Bacteremia in the Era of Multidrug Resistance.
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Martinez-Nadal G, Puerta-Alcalde P, Gudiol C, Cardozo C, Albasanz-Puig A, Marco F, Laporte-Amargós J, Moreno-García E, Domingo-Doménech E, Chumbita M, Martínez JA, Soriano A, Carratalà J, and Garcia-Vidal C
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- Anti-Bacterial Agents therapeutic use, Drug Resistance, Multiple, Humans, Prospective Studies, Pseudomonas aeruginosa, Risk Factors, Bacteremia drug therapy
- Abstract
Background: We aimed to describe the current rates of inappropriate empirical antibiotic treatment (IEAT) in oncohematological patients with febrile neutropenia (FN) and its impact on mortality., Methods: This was a multicenter prospective study of all episodes of bloodstream infection (BSI) in high-risk FN patients (2006-2017). Episodes receiving IEAT were compared with episodes receiving appropriate empirical therapy. Adherence to Infectious Diseases Society of America (IDSA) recommendations was evaluated. Multivariate analysis was performed to identify independent risk factors for mortality in Pseudomonas aeruginosa episodes., Results: Of 1615 episodes, including Escherichia coli (24%), coagulase-negative staphylococci (21%), and P. aeruginosa (16%), 394 (24%) received IEAT despite IDSA recommendations being followed in 87% of cases. Patients with multidrug-resistant gram-negative bacilli (MDR-GNB), accounting for 221 (14%) of all isolates, were more likely to receive IEAT (39% vs 7%, P < .001). Overall mortality was higher in patients with GNB BSI who received IEAT (36% vs 24%, P = .004); when considering individual microorganisms, only patients with infection caused by P. aeruginosa experienced a significant increase in mortality when receiving IEAT (48% vs 31%, P = .027). Independent risk factors for mortality in PA BSI (odds ratio [95% confidence interval] were IEAT (2.41 [1.19-4.91]), shock at onset (4.62 [2.49-8.56]), and pneumonia (3.01 [1.55-5.83])., Conclusions: IEAT is frequent in high-risk patients with FN and BSI, despite high adherence to guidelines. This inappropriate treatment primarily impacts patients with P. aeruginosa-related BSI mortality and in turn is the only modifiable factor to improve outcomes., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2020
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6. Impact of antibiotic resistance on outcomes of neutropenic cancer patients with Pseudomonas aeruginosa bacteraemia (IRONIC study): study protocol of a retrospective multicentre international study.
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Albasanz-Puig A, Gudiol C, Parody R, Tebe C, Akova M, Araos R, Bote A, Brunel AS, Calik S, Drgona L, García E, Hemmati P, Herrera F, Ibrahim KY, Isler B, Kanj S, Kern W, Maestro de la Calle G, Manzur A, Marin JI, Márquez-Gómez I, Martín-Dávila P, Mikulska M, Montejo JM, Montero M, Morales HMP, Morales I, Novo A, Oltolini C, Peghin M, Del Pozo JL, Puerta-Alcalde P, Ruiz-Camps I, Sipahi OR, Tilley R, Yáñez L, Gomes MZR, and Carratalà J
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- Anti-Bacterial Agents therapeutic use, Bacteremia mortality, Cephalosporins therapeutic use, Humans, International Cooperation, Logistic Models, Multicenter Studies as Topic, Observational Studies as Topic, Pseudomonas aeruginosa isolation & purification, Research Design, Retrospective Studies, Tazobactam therapeutic use, Time Factors, Bacteremia drug therapy, Drug Resistance, Multiple, Bacterial, Neoplasms complications, Neutropenia complications, Pseudomonas Infections drug therapy
- Abstract
Introduction: Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality., Methods and Analysis: This is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic onco-haematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrug-resistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates., Ethics and Dissemination: The Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients' personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peer-reviewed publications., Competing Interests: Competing interests: A-SB received grant from Promex Stiftung fur die Forschung (by Carigest SA), and funding by Gilead to assist to the ECCMID Congress (2018). ORS received speaker’s honorarium from MSD, Astellas, Novartis and Pfizer., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2019
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7. Real-Life Use of Ceftolozane/Tazobactam for the Treatment of Bloodstream Infection Due to Pseudomonas aeruginosa in Neutropenic Hematologic Patients: a Matched Control Study (ZENITH Study)
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Alba Bergas, Adaia Albasanz-Puig, Ana Fernández-Cruz, Marina Machado, Andrés Novo, David van Duin, Carolina Garcia-Vidal, Morgan Hakki, Isabel Ruiz-Camps, José Luis del Pozo, Chiara Oltolini, Catherine DeVoe, Lubos Drgona, Oriol Gasch, Malgorzata Mikulska, Pilar Martín-Dávila, Maddalena Peghin, Lourdes Vázquez, Júlia Laporte-Amargós, Xavier Durà-Miralles, Natàlia Pallarès, Eva González-Barca, Ana Álvarez-Uría, Pedro Puerta-Alcalde, Juan Aguilar-Company, Francisco Carmona-Torre, Teresa Daniela Clerici, Sarah B. Doernberg, Lucía Petrikova, Silvia Capilla, Laura Magnasco, Jesús Fortún, Nadia Castaldo, Jordi Carratalà, and Carlota Gudiol
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multidrug-resistant ,Pseudomonas aeruginosa ,bacteremia ,bloodstream infection ,neutropenia ,hematologic malignancy ,Microbiology ,QR1-502 - Abstract
ABSTRACT We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T.
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- 2022
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8. Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance
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Carlota Gudiol, Adaia Albasanz-Puig, Guillermo Cuervo, and Jordi Carratalà
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sepsis ,septic shock ,cancer ,bacteremia ,bloodstream infection ,neutropenia ,Medicine (General) ,R5-920 - Abstract
Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients; (2) the risk factors associated with a worse prognosis; (3) the impact of adequate initial empirical antibiotic therapy given the current era of widespread antimicrobial resistance; and (4) the optimal management of sepsis, including adequate and early source control of infection, optimized antibiotic use based on the pharmacokinetic and pharmacodynamics changes in these patients, and the role of the new available antibiotics.
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- 2021
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9. 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, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (España), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (España), European Society of Clinical Microbiology and Infectious Diseases, and Generalitat de Catalunya
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Microbiology (medical) ,Hematologic Malignancies ,Resistance ,Pseudomonas aeruginosa ,bloodstream infection ,pneumonia ,septic shock ,neutropenia ,Pneumònia ,Antibiòtics ,Bacteremia ,Guidelines ,Monotherapy ,Microbiology ,Oncología ,Infectious-Diseases Society ,Antibiotics ,Virology ,Risk-Factors - Abstract
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., Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Centro de Investigacion Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain [CB21/13/00009, CB21/13/00079, CB21/13/00054, CB21/13/00086, CB21/13/00012], This work was supported by the Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Centro de Investigacion Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC) [CB21/13/00009, CB21/13/00079, CB21/13/00054, CB21/13/00086, CB21/13/00012], Madrid, Spain.
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- 2022
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10. Impact of Empirical Antibiotic Regimens on Mortality in Neutropenic Patients with Bloodstream Infection Presenting with Septic Shock
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Alex Soriano, Júlia Laporte-Amargós, Mariana Chumbita, Jordi Carratalà, Maria Condom, Carolina Garcia-Vidal, Andrea Ladino, María Suárez-Lledó, Carlota Gudiol, Francesc Marco, Enric Sastre, Ignacio Grafia, Josep Mensa, Alba Bergas, Cristina Helguera, José Antonio Martínez, Adaia Albasanz-Puig, Pedro Castro, Nicole Garcia-Pouton, Xavier Durà, Carlota Jordan, and Pedro Puerta-Alcalde
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medicine.medical_specialty ,Multivariate analysis ,Combination therapy ,medicine.drug_class ,Antibiotics ,Bacteremia ,Clinical Therapeutics ,Internal medicine ,Bloodstream infection ,Sepsis ,medicine ,Humans ,Pharmacology (medical) ,Prospective Studies ,Aged ,Retrospective Studies ,Pharmacology ,business.industry ,Septic shock ,Acute kidney injury ,Retrospective cohort study ,bacterial infections and mycoses ,medicine.disease ,Shock, Septic ,Anti-Bacterial Agents ,Infectious Diseases ,Amikacin ,business ,medicine.drug - Abstract
We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. A multicenter retrospective study (2010 to 2019) of two prospective cohorts compared BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Of 1,563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% versus 15%, P 70 years (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2 to 4.7), IEAT for Candida spp. or Gram-negative bacilli (OR, 3.8; 95% CI, 1.3 to 11.1), acute kidney injury (OR, 2.6; 95% CI, 1.4 to 4.9), and amikacin as the only active antibiotic (OR, 15.2; 95% CI, 1.7 to 134.5) were independent risk factors for mortality, while the combination of β-lactam and amikacin was protective (OR, 0.32; 95% CI, 0.18 to 0.57). Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.
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- 2022
11. Real-life use of ceftolozane/tazobactam for the treatment of bloodstream infection due to Pseudomonas aeruginosa in neutropenic hematologic patients: a matched control study (ZENITH study)
- Author
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Bergas, A. (Alba), Albasanz-Puig, A. (Adaia), Fernández-Cruz, A. (Ana), Machado, M. (Marina), Novo, A. (Andrés), Van-Duin, D. (David), Garcia-Vidal, C. (C.), Hakki, M. (Morgan), Ruiz-Camps, I. (Isabel), Pozo, J.L. (José Luis) del, Oltolini, C. (Chiara), DeVoe, C. (Catherine), Drgona, L. (Lubos), Gasch, O. (Oriol), Mikulska, M. (Malgorzata), Martín-Dávila, P. (Pilar), Peghin, M. (Maddalena), Laporte-Amargos, J. (J.), Durà-Miralles, X. (Xavier), Pallarès, N. (Natàlia), González-Barca, E. (Eva), Álvarez-Uría, A. (Ana), Puerta-Alcalde, P. (Pedro), Aguilar-Company, J. (Juan), Carmona-Torre, F. (Francisco de A.), Clerici, T.D. (Teresa Daniela), Doernberg, S.B. (Sarah B.), Petrikova, L. (Lucía), Capilla, S. (Silvia), Magnasco, L. (Laura), Fortún, J. (Jesús), Castaldo, N. (Nadia), Carratalà, J. (Jordi), and Gudiol, C. (Carlota)
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Hematologic malignancy ,Tazobactam ,Neutropenia ,Epidemiology ,Pseudomonas aeruginosa ,Multidrug-resistant ,Bacteremia ,Gram-negative infections ,Ceftolozane/Tazobactam ,Therapy ,Bloodstream infection ,Malignancies - Abstract
We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T. Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited.
- Published
- 2022
12. Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study)
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Mercadal S, P. Puerta-Alcalde, Marina Machado, Jordi Carratalà, Carol Garcia-Vidal, Murat Akova, Celia Cardozo, Jesús Fortún, Bergas A, Natalia Pallares, C.M. Ayaz, Pilar Martín-Dávila, X Durà-Miralles, Carlota Gudiol, F. Herrera, Júlia Laporte-Amargós, H Pomares, Patricia Muñoz, Adaia Albasanz-Puig, A Álvarez-Uría, Torres D, and E García-Lerma
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0301 basic medicine ,medicine.medical_specialty ,Combination therapy ,Cefepime ,030106 microbiology ,Bacteremia ,Clinical Therapeutics ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Sepsis ,Case fatality rate ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Retrospective Studies ,Pharmacology ,business.industry ,Aminoglycoside ,Odds ratio ,medicine.disease ,Anti-Bacterial Agents ,Regimen ,Infectious Diseases ,Aminoglycosides ,Amikacin ,Drug Therapy, Combination ,business ,Gram-Negative Bacterial Infections ,Febrile neutropenia ,medicine.drug - Abstract
To test the hypothesis that the addition of an aminoglycoside to a β-lactam antibiotic could provide better outcomes than β-lactam monotherapy for the initial empirical treatment of hematological neutropenic patients with subsequently documented Gram-negative bacillus (GNB) bloodstream infection (BSI), a multinational, retrospective, cohort study of GNB BSI episodes in hematological neutropenic patients in six centers (2010 to 2017) was conducted. Combination therapy (β-lactam plus aminoglycoside) was compared to β-lactam monotherapy. The primary endpoint was the case fatality rate, assessed at 7 and 30 days from BSI onset. Secondary endpoints were nephrotoxicity and persistent BSI. Propensity score (PS) matching was performed. Among 542 GNB BSI episodes, 304 (56%) were initially treated with combination therapy, with cefepime plus amikacin being most common (158/304 [52%]). Overall, Escherichia coli (273/304 [50.4%]) was the main etiological agent, followed by Pseudomonas aeruginosa, which predominated in the combination group (76/304 [25%] versus 28/238 [11.8%]; P
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- 2021
13. Impact of antibiotic resistance on outcomes of neutropenic cancer patients with Pseudomonas aeruginosa bacteraemia (IRONIC study): study protocol of a retrospective multicentre international study
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Albasanz-Puig, Adaia, Gudiol, Carlota, Parody, Rocio, Tebe, Cristian, Akova, Murat, Araos, Rafael, Bote, Anna, Brunel, Anne-Sophie, Calik, Sebnem, Drgona, Lubos, Garcia, Estefania, Hemmati, Philipp, Herrera, Fabian, Ibrahim, Karim Yaqub, Isler, Burcu, Kanj, Souha, Kern, Winfried, Maestro de la Calle, Guillermo, Manzur, Adriana, Ivan Marin, Jorge, Marquez-Gomez, Ignacio, Martin-Davila, Pilar, Mikulska, Malgorzata, Montejo, Jose Miguel, Montero, Milagros, Paz Morales, Hugo Manuel, Morales, Isabel, Novo, Andres, Oltolini, Chiara, Peghin, Maddalena, Luis del Pozo, Jose, Puerta-Alcalde, Pedro, Ruiz-Camps, Isabel, Resat Sipahi, Oguz, Tilley, Robert, Yanez, Lucrecia, Ribeiro Gomes, Marisa Zenaide, Carratala, Jordi, Cuervo, Guillermo, Escrihuela-Vidal, Francesc, Tubau, Fe, Rodriguez Arias, Marisol, Merve Ayaz, Caglayan, Munita, Jose, Gasch, Oriol, Capilla, Silvia, Bochud, Pierre-Yves, Manuel, Oriol, Torre-Cisneros, Julian, Tabares, Salvador, Serrano Lopez, Josefina, Maschmeyer, Georg, Torres, Diego, Abdala, Edson, Bittencourt, Driele Peixoto, El Zein, Saeed, Jabbour, Jean-Francois, Bertz, Hartmut, Peyerl-Hoffmann, Gabriele, Lizasoain, Manuel, Maria Aguado, Jose, Clemencia Correa, Lina, Palop, Begona, Fortun, Jesus, Magnasco, Laura, Cespedes, Roberto, Lopez-Soria, Leire, Pablo Horcajada, Juan, Montaguti, Mia Hold, de Cueto, Marina, Rodriguez-Bano, Jesus, Greco, Raffaella, Cichero, Paola, Bassetti, Matteo, Castaldo, Nadia, Sangro del Alcazar, Paloma, Cardozo, Celia, Garcia-Vidal, Carolina, Aguilar-Company, Juan, Larrosa, Nieves, Uyan-Onal, Ayse, Nazli-Zeka, Arzu, Vasconcelos de Freitas, Wania, da Silva Machado, Amanda Aparecida, IRONIC Study Grp, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), European Commission, IRONIC study group, Cuervo, G., Escrihuela-Vidal, F., Arias, M.R., Ayaz, C.M., Munita, J., Gasch, O., Bochud, P.Y., Manuel, O., Torres, D., Zein, S.E., Jabbour, J.F., Bertz, H., Peyerl-Hoffmann, G., Lizasoain, M., Aguado, J.M., Palop, B., Fortún, J., Maschmeyer, G., Magnasco, L., Céspedes, R., López-Soria, L., Horcajada, J.P., Montaguti, M.H., Cueto, M., Rodríguez-Baño, J., Greco, R., Cichero, P., Bassetti, M., Castaldo, N., Del Alcázar, P.S., Cardozo, C., Garcia-Vidal, C., Aguilar-Company, J., Larrosa, N., Uyan-Onal, A., Nazli-Zeka, A., Eylul, D., Turkey, I., Clemencia Correa, L., de Freitas, W.V., da Silva Machado, A.A., Institut Català de la Salut, [Albasanz-Puig A, Gudiol C] Departament de Malalties Infeccioses, Hospital Universitari de Bellvitge, Barcelona, Spain. Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain. Universitat de Barcelona, Barcelona, Spain. Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain. [Parody R] Departament d’hematologia, Institut Català d' Oncologia (ICO) Barcelona, Spain. Hospital Duran i Reynals, Barcelona, Spain. . Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain. [Tebe C] Servei d’estadística, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain. Universitat Rovira i Virgili, Barcelona, Spain. [Akova M] Infectious Diseases Department, Hacettepe University School of Medicine, Ankara, Turkey. [Araos R] Infectious Diseases Department, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago de Chile, Chile. [Ruiz-Camps I] Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, and Ege Üniversitesi
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Microbiological Phenomena::Drug Resistance, Microbial [PHENOMENA AND PROCESSES] ,Research design ,infecciones bacterianas y micosis::infecciones bacterianas y micosis::infección::sepsis::bacteriemia [ENFERMEDADES] ,bacteraemia ,Time Factors ,modelos logísticos ,International Cooperation ,humanos ,resistencia a medicamentos ,Drug Resistance ,Bacteremia ,Bacteria::bacterias gramnegativas::bacterias aerobias gramnegativas::bacilos y cocos aerobios gramnegativos::Pseudomonadaceae::Pseudomonas::Pseudomonas aeruginosa [ORGANISMOS] ,bloodstream infection ,multidrug-resistant ,neutropenia ,onco-haematological patients ,pseudomonas aeruginosa ,estudios multicéntricos como asunto ,Bacterièmia ,0302 clinical medicine ,Bacteria::Gram-Negative Bacteria::Gram-Negative Aerobic Bacteria::Gram-Negative Aerobic Rods and Cocci::Pseudomonadaceae::Pseudomonas::Pseudomonas aeruginosa [ORGANISMS] ,Drug Resistance, Multiple, Bacterial ,Neoplasms ,Clinical endpoint ,Onco-haematological patients ,Multicenter Studies as Topic ,Multidrug-resistant ,Microorganismes - Resistència als medicaments ,Otros calificadores::Otros calificadores::/inmunología [Otros calificadores] ,030212 general & internal medicine ,neoplasias ,0303 health sciences ,Neutropènia ,fenómenos microbiológicos::farmacorresistencia microbiana [FENÓMENOS Y PROCESOS] ,Incidence (epidemiology) ,bacteriemia ,General Medicine ,Bacterial Infections and Mycoses::Bacterial Infections and Mycoses::Infection::Sepsis::Bacteremia [DISEASES] ,Anti-Bacterial Agents ,Malalts de càncer ,Observational Studies as Topic ,Research Design ,Pseudomonas aeruginosa ,Ceftolozane ,antibacterianos ,medicine.drug ,medicine.medical_specialty ,Tazobactam ,Neutropenia ,Pseudomones aeruginosa ,Bloodstream infection ,03 medical and health sciences ,factores de tiempo ,Other subheadings::Other subheadings::/immunology [Other subheadings] ,Internal medicine ,Pseudomonas ,medicine ,Humans ,Pseudomonas Infections ,Anti-Bacterial Agents/therapeutic use ,Bacteremia/drug therapy ,Bacteremia/mortality ,Cephalosporins/therapeutic use ,Logistic Models ,Neoplasms/complications ,Neutropenia/complications ,Pseudomonas Infections/drug therapy ,Pseudomonas aeruginosa/isolation & purification ,Retrospective Studies ,Tazobactam/therapeutic use ,Resistència als medicaments ,infecciones por Pseudomonas ,cefalosporinas ,030306 microbiology ,business.industry ,estudios retrospectivos ,enfermedades hematológicas y linfáticas::enfermedades hematológicas::trastornos leucocitarios::leucopenia::agranulocitosis::neutropenia [ENFERMEDADES] ,cooperación internacional ,Retrospective cohort study ,Cancer patients ,medicine.disease ,Cephalosporins ,Drug resistance ,Hemic and Lymphatic Diseases::Hematologic Diseases::Leukocyte Disorders::Leukopenia::Agranulocytosis::Neutropenia [DISEASES] ,Bacteraemia ,Observational study ,business ,diseño de la investigación - Abstract
The IRONIC study group: Cuervo, Guillermo; Escrihuela-Vidal, Francesc; Tubau, Fe; Rodriguez Arias, Marisol; Merve Ayaz, Caglayan; Munita, Jose; Gasch, Oriol; Capilla, Silvia; Bochud, Pierre-Yves; Manuel, Oriol; Torre-Cisneros, Julian; Tabares, Salvador; Serrano Lopez, Josefina; Maschmeyer, Georg; Torres, Diego; Abdala, Edson; Bittencourt, Driele Peixoto; El Zein, Saeed; Jabbour, Jean-Francois; Bertz, Hartmut; Peyerl-Hoffmann, Gabriele; Lizasoain, Manuel; Maria Aguado, Jose; Clemencia Correa, Lina; Palop, Begona; Fortun, Jesus; Magnasco, Laura; Cespedes, Roberto; Lopez-Soria, Leire; Pablo Horcajada, Juan; Montaguti, Mia Hold; de Cueto, Marina; Rodriguez-Bano, Jesus; Greco, Raffaella; Cichero, Paola; Bassetti, Matteo; Castaldo, Nadia; Sangro del Alcazar, Paloma; Cardozo, Celia; Garcia-Vidal, Carolina; Aguilar-Company, Juan; Larrosa, Nieves; Uyan-Onal, Ayse; Nazli-Zeka, Arzu; Vasconcelos de Freitas, Wania; da Silva Machado, Amanda Aparecida, [Introduction]: Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality., [Methods and analysis]: This is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic oncohaematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrugresistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates., [Ethics and dissemination]: The Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients’ personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peerreviewed publications., This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001) and co-financed by European Development Regional Fund “A way to achieve Europe”, Operative Programme Intelligent Growth 2014‐2020.
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- 2019
14. Clinical predictive model of multidrug resistance in neutropenic cancer patients with bloodstream infection due to Pseudomonas aeruginosa
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Herrera, F., Cuervo, Guillermo, Carratalà, J., Novo, A., Manzur, A., Tilley, R., Yáñez, L., Del Pozo, J.L., Peghin, M., Araos, R., Hemmatti, P., Gomes, M.Z.R., Marin, J.I., Márquez-Gómez, I., Calik, S., Sipahi, O.R., Kanj, S.S., Montero, M., Maestro-De La Calle, G., Morales, I., Kern, W.V., Isler, B., García, E., Brunel, A.-S., Paz Morales, H., Drgona, L., Gasch, O., Tubau, Fe, Escrihuela-Vidal, Francesc, Martín-Dávila, P., Aguado, José María, Horcajada, Juan Pablo, Mikulska, M., Tebé, Cristian, Arias, Marisol Rodríguez, Aguilar-Company, Juan, Larrosa, Nieves, Cardozo, Celia, Garcia-Vidal, Carolina, Karim-Yaqub, Ibrahim, Greco, Raffaella, Montejo, M., AKOVA, MURAT, Oltolini, C., Abdala, E., Puerta-Alcalde, P., Ruiz-Camps, I., Mussetti, A., Pallarès, N., Laporte-Amargós, J., Albasanz-Puig, A., Gudiol, C., Cichero, Paola, Ayaz, Caglayan Merve, Céspedes, Roberto, López-Soria, Leire, Magnasco, Laura, Fortún, Jesús, Torres, Diego, Boté, Anna, Espasa, Mateu, Montaguti, Mia Hold, Bochud, Pierre-Yves, Manuel, Oriol, Carrasco, Salvador Tabares, López, Josefina Serrano, Bertz, Hartmut, Rieg, Siegbert, De Cueto, Marina, Rodríguez-Baño, Jesús, Lizasoain, Manuel, Sangro Del Alcázar, Paloma, Castaldo, Nadia, Bassetti, Matteo, Munita, Jose, Maschmeyer, Georg, Tonhá, João Pedro Silva, Aparecida Da Silva Machado, Amanda, Correa, Lina Clemencia, Palop, Begoña, Nazli-Zeka, Arzu, Uyan-Onal, Ayse, Jabbour, Jean-Francois, El Zein, Saeed, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Red Española de Investigación en Patología Infecciosa, European Commission, Promex Stiftung Fur Die Forschung, Gilead Sciences, MSD, Astellas Pharma, Novartis, Pfizer, and Ege Üniversitesi
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Male ,Carbapenem ,Bacteremia ,predictive model ,0302 clinical medicine ,Risk Factors ,Drug Resistance, Multiple, Bacterial ,Neoplasms ,Pharmacology (medical) ,030212 general & internal medicine ,Antibiotic prophylaxis ,Cancer ,0303 health sciences ,Middle Aged ,Antibiotic coverage ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,Pseudomonas aeruginosa ,Female ,medicine.drug ,medicine.medical_specialty ,Neutropenia ,Antibiotic sensitivity ,bloodstream infection ,Microbial Sensitivity Tests ,Tazobactam ,Models, Biological ,Epidemiology and Surveillance ,03 medical and health sciences ,Internal medicine ,medicine ,cancer ,Humans ,Pseudomonas Infections ,multidrug resistant, Pseudomonas aeruginosa, bacteremia, bloodstream infection, neutropenia, cancer, risk factors, predictive model ,Retrospective Studies ,Pharmacology ,030306 microbiology ,business.industry ,multidrug resistant ,Retrospective cohort study ,Odds ratio ,Multidrug resistant ,Risk factors ,ROC Curve ,Predictive model ,Bloodstream infections ,business ,Bloodstream infection ,Piperacillin - Abstract
We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. of a total of 1,217 episodes of BSI due to P. aeruginosa, 309 episodes (25.4%) were caused by MDR strains. the rate of multidrug resistance increased significantly over the study period (P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR), 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa. the application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development., ESGBIES study group; ESGICH study group; Spanish Plan Nacional de I+D+i 2013-2016; Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001]; European Development Regional Fund A Way To Achieve Europe, Operative Program Intelligent Growth 2014-2020; Promex Stiftung fur die Forschung (Carigest SA); GileadGilead Sciences; PfizerPfizer, We thank the ESGBIES and the ESGICH study groups for supporting the study.; This study was supported by the Spanish Plan Nacional de I+D+i 2013-2016 and the Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (grant REIPI RD16/0016/0001), cofinanced by the European Development Regional Fund A Way To Achieve Europe, Operative Program Intelligent Growth 2014-2020.; A.-S.B. received a grant from Promex Stiftung fur die Forschung (via Carigest SA) and funding from Gilead to attend the ECCMID Congress (2018). O.R.S. received speaker honoraria from MSD, Astellas, Novartis, and Pfizer. S.S.K. received speaker honoraria from Pfizer, MSD, Astellas. F.H. received speaker honoraria from MSD, and Pfizer and a research and educational grant from Pfizer. the rest of the authors declare no conflicts of interest.
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- 2020
15. Impact of antibiotic resistance on outcomes of neutropenic cancer patients with
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Adaia, Albasanz-Puig, Carlota, Gudiol, Rocío, Parody, Cristian, Tebe, Murat, Akova, Rafael, Araos, Anna, Bote, Anne-Sophie, Brunel, Sebnem, Calik, Lubos, Drgona, Estefanía, García, Philipp, Hemmati, Fabián, Herrera, Karim Yaqub, Ibrahim, Burcu, Isler, Souha, Kanj, Winfried, Kern, Guillermo, Maestro de la Calle, Adriana, Manzur, Jorge Iván, Marin, Ignacio, Márquez-Gómez, Pilar, Martín-Dávila, Malgorzata, Mikulska, José Miguel, Montejo, Milagros, Montero, Hugo Manuel Paz, Morales, Isabel, Morales, Andrés, Novo, Chiara, Oltolini, Maddalena, Peghin, Jose Luis, Del Pozo, Pedro, Puerta-Alcalde, Isabel, Ruiz-Camps, Oguz Resat, Sipahi, Robert, Tilley, Lucrecia, Yáñez, Marisa Zenaide Ribeiro, Gomes, Jordi, Carratalà, and Amanda Aparecida, da Silva Machado
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Tazobactam ,bacteraemia ,Neutropenia ,Time Factors ,International Cooperation ,multidrug-resistant ,onco-haematological patients ,Bacteremia ,bloodstream infection ,pseudomonas aeruginosa ,Anti-Bacterial Agents ,Cephalosporins ,Observational Studies as Topic ,Logistic Models ,Infectious Diseases ,Research Design ,Drug Resistance, Multiple, Bacterial ,Neoplasms ,Protocol ,Humans ,Multicenter Studies as Topic ,Pseudomonas Infections ,Retrospective Studies - Abstract
Introduction Pseudomonas aeruginosa (PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality. Methods and analysis This is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic onco-haematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrug-resistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates. Ethics and dissemination The Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients’ personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peer-reviewed publications.
- Published
- 2019
16. Inappropriate Empirical Antibiotic Treatment in High-risk Neutropenic Patients With Bacteremia in the Era of Multidrug Resistance
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Gemma Martinez-Nadal, Carlota Gudiol, Pedro Puerta-Alcalde, Alex Soriano, Carolina Garcia-Vidal, Celia Cardozo, Júlia Laporte-Amargós, Estela Moreno-García, Eva Domingo-Domenech, Adaia Albasanz-Puig, Francesc Marco, Mariana Chumbita, Jordi Carratalà, and José Antonio Martínez
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,030106 microbiology ,Antibiotics ,Bacteremia ,Neutropenia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,business.industry ,Odds ratio ,medicine.disease ,Drug Resistance, Multiple ,Confidence interval ,Anti-Bacterial Agents ,Pneumonia ,Infectious Diseases ,Pseudomonas aeruginosa ,business ,Febrile neutropenia - Abstract
Background We aimed to describe the current rates of inappropriate empirical antibiotic treatment (IEAT) in oncohematological patients with febrile neutropenia (FN) and its impact on mortality. Methods This was a multicenter prospective study of all episodes of bloodstream infection (BSI) in high-risk FN patients (2006–2017). Episodes receiving IEAT were compared with episodes receiving appropriate empirical therapy. Adherence to Infectious Diseases Society of America (IDSA) recommendations was evaluated. Multivariate analysis was performed to identify independent risk factors for mortality in Pseudomonas aeruginosa episodes. Results Of 1615 episodes, including Escherichia coli (24%), coagulase-negative staphylococci (21%), and P. aeruginosa (16%), 394 (24%) received IEAT despite IDSA recommendations being followed in 87% of cases. Patients with multidrug-resistant gram-negative bacilli (MDR-GNB), accounting for 221 (14%) of all isolates, were more likely to receive IEAT (39% vs 7%, P < .001). Overall mortality was higher in patients with GNB BSI who received IEAT (36% vs 24%, P = .004); when considering individual microorganisms, only patients with infection caused by P. aeruginosa experienced a significant increase in mortality when receiving IEAT (48% vs 31%, P = .027). Independent risk factors for mortality in PA BSI (odds ratio [95% confidence interval] were IEAT (2.41 [1.19–4.91]), shock at onset (4.62 [2.49–8.56]), and pneumonia (3.01 [1.55–5.83]). Conclusions IEAT is frequent in high-risk patients with FN and BSI, despite high adherence to guidelines. This inappropriate treatment primarily impacts patients with P. aeruginosa–related BSI mortality and in turn is the only modifiable factor to improve outcomes.
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- 2019
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