An Emergent Change in Epidemiologic and Microbiological Characteristics of Bloodstream Infections in Adults With Febrile Neutropenia Resulting From Chemotherapy for Acute Leukemia and Lymphoma at Reference Centers in Chile, Ecuador, and Peru

Ricardo Rabagliati; Grace Salazar; Giancarlo Pérez-Lazo; Maria Paz Iturrieta; Diana Portillo; Carmen Soria-Segarra; María José Ojeda; Jimena Flores; Margarita Galarza; Roxana Sandoval-Ahumada; Pablo Cartes Aguilera; Lady Dimitrakis; Fabiola Avelga Reinoso; Patricia Garcia

doi:10.1093/ofid/ofae052

An Emergent Change in Epidemiologic and Microbiological Characteristics of Bloodstream Infections in Adults With Febrile Neutropenia Resulting From Chemotherapy for Acute Leukemia and Lymphoma at Reference Centers in Chile, Ecuador, and Peru

Open Forum Infect Dis. 2024 Feb 1;11(3):ofae052. doi: 10.1093/ofid/ofae052. eCollection 2024 Mar.

Authors

Affiliations

¹ Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
² Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.
³ Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.
⁴ Hospital Sótero del Río, Santiago, Chile.
⁵ Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú.
⁶ Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador.
⁷ Laboratorio Microbiología, Hospital Eugenio Espejo, Quito, Ecuador.
⁸ Laboratorio Microbiología, Hospital Sótero del Río, Santiago, Chile.
⁹ Laboratorio Microbiología, Sociedad Lucha contra el Cáncer SOLCA, Guayaquil, Ecuador.
¹⁰ Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Abstract

Background: Febrile neutropenia is a life-threatening condition commonly observed in patients with hematologic malignancies. The aim of this article is to provide updated knowledge about bloodstream infections in febrile neutropenia episodes within the Andean region of Latin America.

Method: This retrospective study was based in 6 hospitals in Chile, Ecuador, and Peru and included adult patients with acute leukemia or lymphoma and febrile neutropenia between January 2019 and December 2020.

Results: Of the 416 febrile neutropenia episodes, 38.7% had a bloodstream infection, 86% of which were caused by gram-negative rods, with Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa being the most frequently identified bacteria. K pneumoniae isolates were more frequently resistant than E coli to cefotaxime (65% vs 39.6%), piperacillin-tazobactam (56.7% vs 27.1%), and imipenem (35% vs 2.1%) and were more frequently multidrug resistant (61.7% vs 12.5%). Among P aeruginosa, 26.7% were resistant to ceftazidime, piperacillin-tazobactam, and imipenem, and 23.3% were multidrug resistant. Overall 30-day mortality was 19.8%, being higher with vs without a bloodstream infection (26.7% vs 15.3%, P = .005). Fever duration was also significantly longer, as well as periods of neutropenia and length of hospital stay for patients with bloodstream infection. Additionally, the 30-day mortality rate was higher for episodes with inappropriate vs appropriate empirical antibiotic therapy (41.2% vs 26.6%, P = .139).

Conclusions: Considering the high rates of bacteria-resistant infection and 30-day mortality, it is imperative to establish strategies that reduce the frequency of bloodstream infections, increasing early identification of patients at higher risks of multidrug bacteria resistance, and updating existing empirical antibiotic recommendations.

Keywords: bloodstream infection; febrile neutropenia; gram-negative rods; multidrug resistance.