Different clinical presentation of community-onset bacteremia among neutropenic adults in the ED.

Abstract

OBJECTIVES:

To analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department.

METHODS:

A case-control study with a ratio of 1:2 was conducted retrospectively over a 6-year period. Demographic characteristics, microorganisms, severity of illness, and clinical outcomes determined from medical records were analyzed.

RESULTS:

In total, 116 neutropenic adults (case patients) and 232 nonneutropenic adults (control patients) were examined. Significant differences in the source of bacteremia, susceptibility, and species of bacteremia-causing organisms between the case patients and control patients were observed by univariate analyses. Significantly more patients presenting with an initial syndrome of severe sepsis or septic shock at the emergency department, having high Pittsburgh bacteremia scores (≥4 points) or having severe comorbidities (McCabe classification), and high 28-day mortality rates were discovered in the case group, compared with the control group. Of note, Pseudomonas aeruginosa (32/137 [23.4%] vs 8/272 [2.9%], P < .001) was more often isolated from the case patients. In a further analysis using a multivariate regression to demonstrate the independent predictors of P aeruginosa infection, patients with neutropenia remained as an independent risk factors (odds ratio, 7.48; P < .001).

CONCLUSIONS:

This study demonstrated obvious differences of community-onset bacteremia in severity, the distribution of microorganisms, and susceptibility between neutropenic and nonneutropenic patients. Antipseudomonas therapy was empirically suggested for neutropenic patients with community-onset bacteremia and reducing the need for a glycopeptide.

• Authors: Ching-Chi Lee, Chih-Chia Hsieh, Nan-Yao Lee, Tsung-Yu Chan, Ming-Yuan Hong, Chih-Hsien Chi, Wen-Chien Ko
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 33 Issue 7 Pg. 907-12 (Jul 2015) ISSN: 1532-8171 [Electronic] United States
• PMID: 25959847 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Immunosuppressive Agents

Topics

• Aged
• Antineoplastic Agents (adverse effects)
• Bacteremia (epidemiology, microbiology)
• Case-Control Studies
• Community-Acquired Infections
• Comorbidity
• Diabetes Mellitus (epidemiology)
• Escherichia coli Infections (epidemiology)
• Female
• Humans
• Hypertension (epidemiology)
• Immunocompromised Host
• Immunosuppressive Agents (adverse effects)
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Neoplasms (complications, epidemiology)
• Neutropenia (epidemiology, etiology)
• Pseudomonas Infections (epidemiology, microbiology)
• Pseudomonas aeruginosa (isolation & purification)
• Renal Insufficiency, Chronic (epidemiology)
• Retrospective Studies
• Sepsis (complications)
• Severity of Illness Index
• Staphylococcal Infections (epidemiology, microbiology)
• Staphylococcus aureus (isolation & purification)