Inappropriate initial antimicrobial therapy for hematological malignancies patients with Gram-negative bloodstream infections
Inappropriate initial antimicrobial therapy (IIAT) may increase the mortality rate of hematological malignancies (HMs) patients with Gram-negative bacteria bloodstream infections (GN-BSI). The aim of this study is to determine whether IIAT affects the prognosis in this patient population and recommend the appropriate antibiotic regimen to minimize IIAT.
We reviewed a retrospective cohort study of 361 HM patients with neutropenic fever from GN-BSI. The patients’ clinical characteristics and the results of the drug sensitivity test in vitro were analyzed.
IIAT rate was 21.3% in HM patients with neutropenic fever caused by GN-BSI. There was a significant difference in 7-day mortality rate between patients treated with appropriate antibiotics and those with IIAT (7.7% vs 29.9%, p < 0.01). Multivariate analysis confirmed that IIAT was an independent risk factors for early mortality [4.860 (1.541–15.323)]. Drug sensitivity data of GN-bacteria suggested that carbapenems monotherapy or beta-lactamase inhibitors (BLBLI) combined with amikacin as the initial therapy can effectively reduce the IIAT rate. In the stratified antibiogram based on prior antimicrobial exposure, our results showed that BLBLI monotherapy could be initially used as an empirical treatment in patients without prior antimicrobial exposure. In those who had received prior antimicrobial exposure, BLBLI (especially piperacillin–tazobactam) combined with amikacin is recommended.
IIAT was a critical factor contributing to the mortality of HM patients with neutropenic fever from GN-BSI.
KeywordsInappropriate initial antimicrobial therapy Hematological malignancies Gram-negative bloodstream infections Febrile neutropenia
We thank all those who helped us in this study, in particular, the Department of Hematology and the Department of Clinical Laboratory for making this study possible. Qing Yang helped us modify the grammar of the manuscript.
This work was supported by the National Natural Science Foundation of China (General Program), no. 81870165 and Fundamental Research Funds for the Central Universities of Central South University, no. 2017zzts837.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest. All authors meet the ICMJE authorship criteria.
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