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The relationship between neutrophil-lymphocyte ratio and antibiotic therapy in patients with fever of unknown origin

Year 2021, , 25 - 31, 22.03.2021
https://doi.org/10.31832/smj.813151

Abstract

Amaç: Ampirik antibiyotik tedavisi, enfeksiyon kaynağınınhenüzbelirlenemediğidurumlardahekimlerinateşiolanhastalarayaygınolarakuyguladıklarıbiryöntemdir.Bu çalışmanın amacı, nedeni bilinmeyen ateşi olan hastalarda (NBA) ampirikantibiyotiktedavisindemaliyet-etkininflamatuarparametreleribelirlemektir.
GereçveYöntemler: KankültürlerialınmışolanNBA iletakipedilentoplam 577 hasta enfeksiyonabağlıateşgrubu (EBAG,n:203) veenfeksiyonabağlıolmayanateşgrubu (EBOAG,n:374) olarakikigrubaayrıldıvebeşyıllıkverileri hasta bilgikayıtsistemindengeriyedönükolarakincelendi. Tam kan test sonuçlarından nötrofil sayısı, lenfosit sayısı parametresine oranlanarak nötrofil lenfosit oranı ve trombosit lenfosit oranı değerleri hesaplandı.
Bulgular: Toplam 577 hasta enfeksiyonabağlıateşgrubu (EBAG) veenfeksiyonabağlıolmayanateşgrubu (EBOAG) olarakikigrubaayrıldı. İlk antibiyotikkullanımsüreleri EBAG veEBOAG'dasırasıyla 4.54 ± 3.08 (1-14)günve 5.35 ± 3.8 (1–21)gündü(p = 0.023). Nötrofil-lenfositoranı (NLO) EBAG’da 8.00 (3.00-15.00)iken, EBOAG’da 5.00 (3.00-9.00)idi (p = 0.001). Trombosit-lenfositoranı (TLO) EBAG’da 21.00(9.00-41.00)iken, EBOAG’da 16.00 (7.25-27.75)idiveanlamlıdeğildi (p = 0.165).
Sonuç:Nötrofillenfositoranırutinkantestlerindenbakılabilenvepahalıbiryöntemolmamasınedeniyle, nedenibelirlenemeyenateşli (NBA)hastalardaavantajlıbirtanımetoduolarakkullanılabilir.

References

  • References 1. Petersdorf, R. G.,Beeson, P. B. Fever of unexplainedorigin: report on 100 cases. Medicine 1961;40, 1–30. 2. Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Durnez A, Blockmans D, et al. From prolonged febrile illness to fever of unknown origin: The challenge continues. Archives of Internal Medicine 2003;163:1033–1041.
  • 3. Unger M, Karanikas G, Kerschbaumer A, Winkler S, Aletaha D. Fever of unknownorigin (FUO) revised. Wien KlinWochenschr 2016;128(21-22):796-801.
  • 4. Steele GM, Franco-Paredes C, Chastain DB. Noninfectious causes of fever in adults. Nurse Practitioner 2018;43:38–44.
  • 5. Knockaert DC, Vanneste LJ, Bobbaers HJ. Fever of Unknown Origin in Elderly Patients. JAGS1993;41:1187–1192.
  • 6. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med 2011;9:107.
  • 7. Terradas R, Grau S, Blanch J, Riu, M., Saballs, P., Castells, X. et al.Eosinophilcountand neutrophil-lymphocyte count ratio as prognostic markers in patients with bacteremia: a retrospective cohort study. PLoSOne 2012;7(8):e42860.
  • 8. Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: Results from a guideline-based performance improvement program. Critical Care Medicine 2014;42:1749–1755.
  • 9. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017; 9:2(2):CD003543.
  • 10. Bryan CS, Ahuja D. Fever of Unknown Origin: Is There a Role for Empiric Therapy? Infectious Disease Clinics of North America.Infect Dis Clin North Am 2007;21:1213–1220. 11. Katchman EA, Milo G, Paul M, Christiaens T, Baerheim A, Leibovici L, et al. Three-day vs longer duration of antibiotic treatment for cystitis in women: Systematic review and meta-analysis. American Journal of Medicine. Am J Med 2005;118:1196–1207.
  • 12. Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM, et al. High‐Dose, Short‐Course Levofloxacin for Community‐Acquired Pneumonia: A New Treatment Paradigm. Clin Infect Dis 2003;37:752–760.
  • 13. Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, et al. Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial. JAMA 2003;290:2588–2598.
  • 14. Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Medical Principles and Practice. S. Karger AG 2017;26:1–9.
  • 15. Weiss G. Iron metabolism in the anemia of chronic disease. Biochimica et Biophysica Acta - General Subjects. Elsevier 2009;1790: 682–693.
  • 16. Mackowiak PA, Bartlett JG, Borden EC, Goldblum SE, Hasday JD, Munford RS, et al. Concepts of Fever: Recent Advances and Lingering Dogma. Clin InfectDis 1997;25:119–138.
  • 17. Sager R, Kutz A, Mueller B, Schuetz P. Procalcitonin-guided diagnosis and antibiotic stewardship revisited. BMC Medicine. BioMed Central Ltd 2017;15:15.
  • 18. Ma, Y., Zhang, L., Rong, S., Qu, H., Zhang, Y., Chang, D. W., et al.Relationbetweengastriccancer and protein oxidation, DNA damage, and lipid peroxidation. OxidMed CellLongev (2013)2013.
  • 19. Zhang CF, Xu R, Li MT, Zeng XF. A clinical analysis on fever of unknown origin in in-patients with systemic lupus erythematosus. Zhonghua Nei Ke Za Zhi 2017;56(4):295-297.
  • 20. Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection 2017;45:299–307.
  • 21. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis 2007;44:S27–72.
  • 22. Lim, W. S., Baudouin, S. V., George, R. C., Hill, A. T., Jamieson, C., Le Jeune, I.,et al.PneumoniaGuidelines Committee of the BTS Standards of Care Committee. BTS guidelines for themanagement of communityacquiredpneumonia in adults 2009;64:3, iii1–iii55.
  • 23. Çilli A, Sayiner A, Çelenk B, Şakar Coşkun A, Kilinç O, Hazar A., et al. Antibiotic treatment outcomes in community-acquired pneumonia. Turk J Med Sci 2018;48:730–736.
  • 24. Alves C, Casqueiro J, Casqueiro J. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian JEndocrinol Metab 2012;16:27.

The relationship between neutrophil-lymphocyte ratio and antibiotic therapy in patients with fever of unknown origin

Year 2021, , 25 - 31, 22.03.2021
https://doi.org/10.31832/smj.813151

Abstract

Objective: Empirical antibiotic therapy is usually applied by physicians to patients with fever when the origin of the infection cannot yet be determined.The aim of this study is to determine the cost-effectiveinflammatoryparametersin empirical antibiotic therapy in patients with fever of unknown origin(FUO).
Materials and Methods:A total of 577 patients, whose blood cultures were taken and followed up by the NBA, were divided into two groups as fever group due to infection(IRFG) and fever group not related to infection(NIRFG), and their five-year data were analyzed retrospectively from the patient information registry system.From the complete blood count test results, the neutrophil count was proportioned to the lymphocyte count parameter, and the neutrophil lymphocyte ratio and thrombocyte lymphocyte ratio values were calculated.
Results: Total of 577 patients were divided into two groups as infection related fever group (IRFG) and non-infection related fever group (NIRFG), and were included in the study. The durations of first antibiotic usages were 4.54 ± 3.08(1–14) days and 5.35 ± 3.8(1–21) days in IRFG and NIRFG, respectively. Neutrophil-to-lymphocyte ratio (NLR) was 8.00 (3.00-15.00) in the IRFG, whereas it was 5.00 (3.00-9) in the NIRFG (p = 0.001). Platelet-to-lymphocyte ratio (PLR) was 21.00 (9.00-41.00) in the IRFG, whereas it was 16.00 (7.25-27.75) in the NIRFG and was not significant (p = 0.165).
Conclusion:Since neutrophil-lymphocyte ratio can be checked from routine blood tests and is not an expensive method, it can be used as an advantageous diagnostic method in patients with fever of unknown origin(FUO).

References

  • References 1. Petersdorf, R. G.,Beeson, P. B. Fever of unexplainedorigin: report on 100 cases. Medicine 1961;40, 1–30. 2. Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Durnez A, Blockmans D, et al. From prolonged febrile illness to fever of unknown origin: The challenge continues. Archives of Internal Medicine 2003;163:1033–1041.
  • 3. Unger M, Karanikas G, Kerschbaumer A, Winkler S, Aletaha D. Fever of unknownorigin (FUO) revised. Wien KlinWochenschr 2016;128(21-22):796-801.
  • 4. Steele GM, Franco-Paredes C, Chastain DB. Noninfectious causes of fever in adults. Nurse Practitioner 2018;43:38–44.
  • 5. Knockaert DC, Vanneste LJ, Bobbaers HJ. Fever of Unknown Origin in Elderly Patients. JAGS1993;41:1187–1192.
  • 6. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med 2011;9:107.
  • 7. Terradas R, Grau S, Blanch J, Riu, M., Saballs, P., Castells, X. et al.Eosinophilcountand neutrophil-lymphocyte count ratio as prognostic markers in patients with bacteremia: a retrospective cohort study. PLoSOne 2012;7(8):e42860.
  • 8. Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: Results from a guideline-based performance improvement program. Critical Care Medicine 2014;42:1749–1755.
  • 9. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017; 9:2(2):CD003543.
  • 10. Bryan CS, Ahuja D. Fever of Unknown Origin: Is There a Role for Empiric Therapy? Infectious Disease Clinics of North America.Infect Dis Clin North Am 2007;21:1213–1220. 11. Katchman EA, Milo G, Paul M, Christiaens T, Baerheim A, Leibovici L, et al. Three-day vs longer duration of antibiotic treatment for cystitis in women: Systematic review and meta-analysis. American Journal of Medicine. Am J Med 2005;118:1196–1207.
  • 12. Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM, et al. High‐Dose, Short‐Course Levofloxacin for Community‐Acquired Pneumonia: A New Treatment Paradigm. Clin Infect Dis 2003;37:752–760.
  • 13. Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, et al. Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial. JAMA 2003;290:2588–2598.
  • 14. Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Medical Principles and Practice. S. Karger AG 2017;26:1–9.
  • 15. Weiss G. Iron metabolism in the anemia of chronic disease. Biochimica et Biophysica Acta - General Subjects. Elsevier 2009;1790: 682–693.
  • 16. Mackowiak PA, Bartlett JG, Borden EC, Goldblum SE, Hasday JD, Munford RS, et al. Concepts of Fever: Recent Advances and Lingering Dogma. Clin InfectDis 1997;25:119–138.
  • 17. Sager R, Kutz A, Mueller B, Schuetz P. Procalcitonin-guided diagnosis and antibiotic stewardship revisited. BMC Medicine. BioMed Central Ltd 2017;15:15.
  • 18. Ma, Y., Zhang, L., Rong, S., Qu, H., Zhang, Y., Chang, D. W., et al.Relationbetweengastriccancer and protein oxidation, DNA damage, and lipid peroxidation. OxidMed CellLongev (2013)2013.
  • 19. Zhang CF, Xu R, Li MT, Zeng XF. A clinical analysis on fever of unknown origin in in-patients with systemic lupus erythematosus. Zhonghua Nei Ke Za Zhi 2017;56(4):295-297.
  • 20. Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection 2017;45:299–307.
  • 21. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis 2007;44:S27–72.
  • 22. Lim, W. S., Baudouin, S. V., George, R. C., Hill, A. T., Jamieson, C., Le Jeune, I.,et al.PneumoniaGuidelines Committee of the BTS Standards of Care Committee. BTS guidelines for themanagement of communityacquiredpneumonia in adults 2009;64:3, iii1–iii55.
  • 23. Çilli A, Sayiner A, Çelenk B, Şakar Coşkun A, Kilinç O, Hazar A., et al. Antibiotic treatment outcomes in community-acquired pneumonia. Turk J Med Sci 2018;48:730–736.
  • 24. Alves C, Casqueiro J, Casqueiro J. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian JEndocrinol Metab 2012;16:27.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Cengiz Karacaer 0000-0002-7164-4810

Oğuz Karabay 0000-0003-1514-1685

Ali Tamer 0000-0003-2005-0737

Publication Date March 22, 2021
Submission Date October 20, 2020
Published in Issue Year 2021

Cite

AMA Karacaer C, Karabay O, Tamer A. The relationship between neutrophil-lymphocyte ratio and antibiotic therapy in patients with fever of unknown origin. Sakarya Tıp Dergisi. March 2021;11(1):25-31. doi:10.31832/smj.813151

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