Abstract：
OBJECTIVE: This study aims to identify infection etiology in febrile neutropenia (FN) is vital. This study explores different microbiological approaches and their impact on diagnosing infections in patients with hematologic malignancies and FN.
METHODS: This is a retrospective analysis conducted at the Hospital Clinic of Barcelona details microbiological testing strategies used to diagnose infections at FN onset between January 2020 and July 2022.
RESULTS: A total of 4520 microbiological tests were ordered in 462 FN episodes, achieving a 10% test positivity rate, with 200 (43.3%) episodes showing microbiological documentation of infection. Blood cultures (40.4%), non-culture blood tests (21.2%), and respiratory tract samples (16.2%) were the most requested. Blood cultures exhibited the highest (16.9%) test positivity rates, whereas non-culture blood tests showed the lowest (3.3%). Bacterial infections were present in 149 of 462 (32.3%) FN episodes. Viral infections (66 of 462, 14.3%)-notably, respiratory viruses-were also frequent. Mortality rate at 60 days was 9.1%; documented infections were associated with a higher risk (15%).
CONCLUSIONS: In the current landscape of antimicrobial diagnostics, our findings revealed the highest reported rate of microbiologically documented infections at FN onset. Bacterial infections are common; however, our data reiterate the significance of viral infections in causing fever. Optimizing FN management during respiratory viral infections remains a challenge for antimicrobial de-escalation. The low positivity rates observed in certain diagnostic tests emphasize the need for cost-effective diagnostic stewardship.
METHODS: This is a retrospective analysis conducted at the Hospital Clinic of Barcelona details microbiological testing strategies used to diagnose infections at FN onset between January 2020 and July 2022.
RESULTS: A total of 4520 microbiological tests were ordered in 462 FN episodes, achieving a 10% test positivity rate, with 200 (43.3%) episodes showing microbiological documentation of infection. Blood cultures (40.4%), non-culture blood tests (21.2%), and respiratory tract samples (16.2%) were the most requested. Blood cultures exhibited the highest (16.9%) test positivity rates, whereas non-culture blood tests showed the lowest (3.3%). Bacterial infections were present in 149 of 462 (32.3%) FN episodes. Viral infections (66 of 462, 14.3%)-notably, respiratory viruses-were also frequent. Mortality rate at 60 days was 9.1%; documented infections were associated with a higher risk (15%).
CONCLUSIONS: In the current landscape of antimicrobial diagnostics, our findings revealed the highest reported rate of microbiologically documented infections at FN onset. Bacterial infections are common; however, our data reiterate the significance of viral infections in causing fever. Optimizing FN management during respiratory viral infections remains a challenge for antimicrobial de-escalation. The low positivity rates observed in certain diagnostic tests emphasize the need for cost-effective diagnostic stewardship.
摘要：
背景：确定发热性中性粒细胞减少症（FN）的感染病因至关重要。这项研究探讨了不同的微生物学方法及其对诊断恶性血液病和FN患者感染的影响。
方法：在巴塞罗那医院诊所进行的回顾性分析详细介绍了用于诊断2020年1月至2022年7月FN发病时感染的微生物检测策略。
结果：在462个FN事件中订购了4520个微生物测试，达到10％的测试阳性率与200（43.3％）的事件显示感染的微生物文件。血培养（40.4%），非培养血液检查(21.2%),呼吸道样本(16.2%),是最有要求的。血液培养显示最高（16.9％）的测试阳性率，而非培养血液测试显示最低（3.3％）。149/462（32.3％）FN发作中存在细菌感染。病毒感染（66/462，14.3％）-特别是呼吸道病毒-也很常见。60天的死亡率为9.1%；记录的感染与较高的风险相关（15%）。
结论：在当前的抗菌诊断领域，我们的研究结果显示,FN发病时微生物学记录的感染率最高.细菌感染很常见；然而，我们的数据重申了病毒感染在引起发热中的重要性.在呼吸道病毒感染期间优化FN管理仍然是抗微生物降级的挑战。在某些诊断测试中观察到的低阳性率强调需要具有成本效益的诊断管理。
方法：在巴塞罗那医院诊所进行的回顾性分析详细介绍了用于诊断2020年1月至2022年7月FN发病时感染的微生物检测策略。
结果：在462个FN事件中订购了4520个微生物测试，达到10％的测试阳性率与200（43.3％）的事件显示感染的微生物文件。血培养（40.4%），非培养血液检查(21.2%),呼吸道样本(16.2%),是最有要求的。血液培养显示最高（16.9％）的测试阳性率，而非培养血液测试显示最低（3.3％）。149/462（32.3％）FN发作中存在细菌感染。病毒感染（66/462，14.3％）-特别是呼吸道病毒-也很常见。60天的死亡率为9.1%；记录的感染与较高的风险相关（15%）。
结论：在当前的抗菌诊断领域，我们的研究结果显示,FN发病时微生物学记录的感染率最高.细菌感染很常见；然而，我们的数据重申了病毒感染在引起发热中的重要性.在呼吸道病毒感染期间优化FN管理仍然是抗微生物降级的挑战。在某些诊断测试中观察到的低阳性率强调需要具有成本效益的诊断管理。
