63c0992ad31e347fd0c0b1671adaf127 pmc_9027680.pdf f82d54bacbcd612f887ade103a348023c08a2085 pmc_9027680.pdf 615edfec4837a7c1088f620e35955635752d258a2e3e99008ded1838768908af pmc_9027680.pdf Title: Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia Subject: 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; pneumonia; septic shock; neutropenia Author: Adaia Albasanz-Puig, Xavier Durà-Miralles, Júlia Laporte-Amargós, Alberto Mussetti, Isabel Ruiz-Camps, Pedro Puerta-Alcalde, Edson Abdala, Chiara Oltolini, Murat Akova, José Miguel Montejo, Malgorzata Mikulska, Pilar Martín-Dávila, Fabián Herrera, Oriol Gasch, Lubos Drgona, Hugo Manuel Paz Morales, Anne-Sophie Brunel, Estefanía García, Burcu Isler, Winfried V. Kern, Pilar Retamar-Gentil, José María Aguado, Milagros Montero, Souha S. Kanj, Oguz R. Sipahi, Sebnem Calik, Ignacio Márquez-Gómez, Jorge I. Marin, Marisa Z. R. Gomes, Philipp Hemmati, Rafael Araos, Maddalena Peghin, José Luis del Pozo, Lucrecia Yáñez, Robert Tilley, Adriana Manzur, Andres Novo, Natàlia Pallarès, Alba Bergas, Jordi Carratalà, Carlota Gudiol and Group on behalf of the IRONIC Study Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Fri Apr 1 09:15:19 2022 CEST ModDate: Fri Apr 8 10:44:45 2022 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1083335 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- CKPGFH+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 MQQTRR+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 ODSXUC+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 GROLCJ+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 VNMKKE+URWPalladioL-BoldItal Type 1 Custom yes yes no 28 0 PZNCIS+VnURWPalladioL Type 1 Custom yes yes no 32 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 40 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 44 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 48 0 SIXRFS+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 60 0 HCPSKZ+CMSY10 Type 1 Builtin yes yes no 88 0 RHAWTP+EURM10 Type 1 Builtin yes yes no 92 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 116 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 120 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 124 0 ABCDEE+Palatino Linotype,BoldItalic TrueType WinAnsi yes yes no 128 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 132 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 147 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 151 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 155 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 159 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-11-17 02:37:00 CET RepresentationInformation: pmc_9027680.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-11-14 02:19:43 CET Size: 1083335 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 341 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Children: Item: Title: Study Design and Setting Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6121c9d6 Item: Title: Ethics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@87f383f Item: Title: Participants Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4eb7f003 Item: Title: Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@eafc191 Item: Title: Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612fc6eb Item: Title: Microbiological Studies Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1060b431 Item: Title: Definitions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612679d6 Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@11758f2a Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@e720b71 Children: Item: Title: Clinical Characteristics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1b26f7b2 Item: Title: Treatment Characteristics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@491cc5c9 Item: Title: Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@74ad1f1f Item: Title: Risk Factors for Mortality in Patients with Bacteremic PA Pneumonia Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6a1aab78 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@462d5aee Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@69b0fd6f Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@757942a1 Info: Title: Effect of Combination Antibiotic Empirical Therapy on Mortality in Neutropenic Cancer Patients with Pseudomonas aeruginosa Pneumonia Author: Adaia Albasanz-Puig, Xavier Durà-Miralles, Júlia Laporte-Amargós, Alberto Mussetti, Isabel Ruiz-Camps, Pedro Puerta-Alcalde, Edson Abdala, Chiara Oltolini, Murat Akova, José Miguel Montejo, Malgorzata Mikulska, Pilar Martín-Dávila, Fabián Herrera, Oriol Gasch, Lubos Drgona, Hugo Manuel Paz Morales, Anne-Sophie Brunel, Estefanía García, Burcu Isler, Winfried V. Kern, Pilar Retamar-Gentil, José María Aguado, Milagros Montero, Souha S. Kanj, Oguz R. Sipahi, Sebnem Calik, Ignacio Márquez-Gómez, Jorge I. Marin, Marisa Z. R. Gomes, Philipp Hemmati, Rafael Araos, Maddalena Peghin, José Luis del Pozo, Lucrecia Yáñez, Robert Tilley, Adriana Manzur, Andres Novo, Natàlia Pallarès, Alba Bergas, Jordi Carratalà, Carlota Gudiol and Group on behalf of the IRONIC Study Subject: 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. 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