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. 2022 Mar 29;10(4):733.
doi: 10.3390/microorganisms10040733.

Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia

Adaia Albasanz-Puig  1   2 , Xavier Durà-Miralles  1 , Júlia Laporte-Amargós  1 , Alberto Mussetti  3 , Isabel Ruiz-Camps  2   4 , Pedro Puerta-Alcalde  5 , Edson Abdala  6 , Chiara Oltolini  7 , Murat Akova  8 , José Miguel Montejo  9 , Malgorzata Mikulska  10 , Pilar Martín-Dávila  2   11 , Fabián Herrera  12 , Oriol Gasch  13 , Lubos Drgona  14 , Hugo Manuel Paz Morales  15 , Anne-Sophie Brunel  16 , Estefanía García  17 , Burcu Isler  18 , Winfried V Kern  19 , Pilar Retamar-Gentil  2   20 , José María Aguado  2   21 , Milagros Montero  22 , Souha S Kanj  23 , Oguz R Sipahi  24 , Sebnem Calik  25 , Ignacio Márquez-Gómez  26 , Jorge I Marin  27 , Marisa Z R Gomes  28 , Philipp Hemmati  29 , Rafael Araos  30 , Maddalena Peghin  31 , José Luis Del Pozo  32 , Lucrecia Yáñez  33 , Robert Tilley  34 , Adriana Manzur  35 , Andres Novo  36 , Natàlia Pallarès  37 , Alba Bergas  1 , Jordi Carratalà  1   2 , Carlota Gudiol  1   2   38 , On Behalf Of The Ironic Study Group
Affiliations

Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia

Adaia Albasanz-Puig et al. Microorganisms. .

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.

Keywords: Pseudomonas aeruginosa; bloodstream infection; neutropenia; pneumonia; septic shock.

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Conflict of interest statement

F.H. received speaker’s fees from MSD and Pfizer and Research and Educational grants from Pfizer. P.R.-G. received speaker’s fees from MSD, Menarini and Shionogui.

Figures

Figure 1
Figure 1
Kaplan–Meier survival analysis of patients with Pseudomonas aeruginosa bacteremic pneumonia, stratified by the appropriateness of empirical treatment.
Figure 2
Figure 2
Kaplan–Meier survival analysis of patients with Pseudomonas aeruginosa bacteremic pneumonia, stratified by treatment group.
See this image and copyright information in PMC

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