The frequency, epidemiology and risk factors of bloodstream infections in febrile neutropenic patients with hematologic malignancies

Öz

Aim: Bacteremia is considered as the most significant cause of mortality and morbidity in febrile neutropenic patients. The epidemiology and risk factors might differ among institutions and over the time period. The aim of this study is to evaluate the frequency, epidemiology and factors predictive of bacteremia in neutropenic patients in a university hospital in Ankara between November 2007 and November 2008. Material and Methods: 177 febrile neutropenic episodes of 115 patients with hematological malignancies were included in this study. Cases were defined as patients with bloodstream infection and controls were the patients without bloodstream infections. We evaluated the cases and controls for the risk factors, complications and mortality rates. Microorganisms isolated from blood samples and their susceptibility patterns were also analysed. Results: The prevalence of bacteremia was 61%, 42.6% of them were catheter related and mortality rate was 12.4%. Bloodstream infections are more common in the patients with uncontrolled underlying disease and long term severe neutropenia. Duration of severe neutropenia (neutrophile count <100/ mm3), underlying hematologic malignancy, stem cell transplantation, relapsing or refractory disease, presence of central venous catheter and presence of mucositis were significant predictive factors for bacteremia. Presence of central venous catheter and relapsing or refractory disease were independent risk factors. Candidemia and gram negative bacteremia were significantly associated with higher mortality rates. Gram-positive microorganisms were the most common isolates (76.8%) with the predominance of coagulase negative staphylococci (63.6%) with methicillin resistance rate of 64%. The most frequent gram-negative pathogen was Escherichia coli with quinolon resistance rate of 82.1%. Conclusion: Monitorization for the epidemiology of bacteremia and prediction of significant factors associated with bacteremia in febrile neutropenic patients are considered to be important for the choice of initial antibiotic therapy.

Anahtar Kelimeler

• Febrile neutropenia
• bloodstream infection
• risk factors

Febril nötropenik hastalarda bakteriyemi sıklığı, risk faktörleri ve epidemiyolojisi

Öz

Amaç: Kan dolaşımı infeksiyonları febril nötropenik hastalarda, ciddi morbidite ve mortalite ile seyretmektedir. Farklı merkezler arasında ve aynı merkezde yıllar içerisinde bakteriyemi epidemiyolojisi ve risk faktörleri değişiklikler göstermektedir. Bu çalışmanın amacı Kasım 2007-Kasım 2008 tarihleri arasında Ankara’da bir üniversite hastanesinde bakteriyemi sıklığını, risk faktörlerini ve epidemiyolojisini belirlemektir. Gereç ve Yöntemler: Çalışmamızda 115 hematolojik maligniteli hastada gelişen 177 febril nötropeni atağı ve 108 kan dolaşımı enfeksiyonu incelenmiştir. Olgular kan dolaşımı enfeksiyonu gelişen, kontrol grup ise gelişmeyen hasta grubu olarak tanımlanmıştır. Olgular ve kontroller risk faktörleri, komplikasyonlar ve mortalite oranları yönünden karşılaştırılmış; izole edilen mikroorganizmalar ve duyarlılık paternleri incelenmiştir. Bulgular: Epizodlarının %61’inde bakteriyemi gelişmiş, bunların %42.6’sı kateterle ilişkili bulunmuş ve atak ilişkili mortalite hızı %12.4 saptanmıştır. Altta yatan malignitesi kontrol altında olmayan, uzun süreli derin nötropenisi olanlarda bakteriyemi daha yüksek oranda izlenmiştir. Kök hücre nakil ünitesinde yatmak, altta yatan malignite tanıları, nakil uygulama türünden bağımsız olarak kök hücre nakli varlığı, malignite evresi, santral venöz kateter, mukozit ve ishal varlığı kan dolaşımı enfeksiyonu gelişimi ile ilişkili bulunmuş; altta yatan malignite evresi ve santral venöz kateter varlığı bağımsız risk faktörleri olarak tanımlanmıştır. En sık etkenleri olarak gram-pozitif bakteriler (%76.8); bunlar içinde de en sık koagülaz negatif stafilokoklar (%63.6) saptanmıştır. Metisilin direnci koagülaz negatif stafilokoklarda %64 bulunmuştur. Gram-negatif bakteriler içerisinde ise en sık Escherichia coli izole edilmiştir. Escherichia coli izolatlarında kinolon direnci %82.1 saptanmıştır. Sonuç: Sonuç olarak febril nötropenik hastalarda kan dolaşımı enfeksiyonu sıklığının, risk faktörlerinin ve epidemiyolojisinin izlemi, her merkezin kendi empirik tedavi yaklaşımını belirleyebilmesi için önemlidir.

Anahtar Kelimeler

• Febril nötropeni
• kan dolaşımı infeksiyonu
• risk faktörleri

Kaynakça

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