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Abstract：
OBJECTIVE: Haematology patients with high-risk neutropenia are prone to mucosal-barrier injury-associated laboratory-confirmed bloodstream infections (MBI-LCBI). We assessed risk factors for MBI-LCBI including candidaemia in neutropenic haematology patients with fever.
METHODS: This prospective observational study was performed in six dedicated haematology units in the Netherlands. Eligible haematology patients had neutropenia < 500/mL for ≥ 7 days and had fever. MBI-LCBIs were classified according to Centers for Disease Control (CDC) definitions and were followed until the end of neutropenia > 500/mL or discharge.
RESULTS: We included 416 patients from December 2014 until August 2019. We observed 63 MBI-LCBIs. Neither clinical mucositis scores nor the blood level of citrulline at fever onset was associated with MBI-LCBI. In the multivariable analysis, MASCC-score (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05 to 1.29 per point decrease), intensive chemotherapy (OR 3·81, 95% CI 2.10 to 6.90) and Pichia kudriavzevii (formerly Candida krusei) colonisation (OR 5.40, 95% CI 1.75 to 16.7) were retained as risk factors for MBI-LCBI, while quinolone use seemed protective (OR 0.42, 95% CI 0.20 to 0.92). Citrulline level (OR 1.57, 95% CI 1.07 to 2.31 per µmol/L decrease), active chronic obstructive pulmonary disease (OR 15.4, 95% CI 1.61 to 14.7) and colonisation with fluconazole-resistant Candida (OR 8.54, 95% CI 1.51 to 48.4) were associated with candidaemia.
CONCLUSIONS: In haematology patients with fever during neutropenia, hypocitrullinaemia at fever onset was associated with candidaemia, but not with bacterial MBI-LCBI. Patients with intensive chemotherapy with a low MASCC-score and colonisation with Pichia kudriavzevii had the highest risk of MBI-LCBI.
BACKGROUND: ClinicalTrials.gov (NCT02149329) at 19-NOV-2014.
METHODS: This prospective observational study was performed in six dedicated haematology units in the Netherlands. Eligible haematology patients had neutropenia < 500/mL for ≥ 7 days and had fever. MBI-LCBIs were classified according to Centers for Disease Control (CDC) definitions and were followed until the end of neutropenia > 500/mL or discharge.
RESULTS: We included 416 patients from December 2014 until August 2019. We observed 63 MBI-LCBIs. Neither clinical mucositis scores nor the blood level of citrulline at fever onset was associated with MBI-LCBI. In the multivariable analysis, MASCC-score (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05 to 1.29 per point decrease), intensive chemotherapy (OR 3·81, 95% CI 2.10 to 6.90) and Pichia kudriavzevii (formerly Candida krusei) colonisation (OR 5.40, 95% CI 1.75 to 16.7) were retained as risk factors for MBI-LCBI, while quinolone use seemed protective (OR 0.42, 95% CI 0.20 to 0.92). Citrulline level (OR 1.57, 95% CI 1.07 to 2.31 per µmol/L decrease), active chronic obstructive pulmonary disease (OR 15.4, 95% CI 1.61 to 14.7) and colonisation with fluconazole-resistant Candida (OR 8.54, 95% CI 1.51 to 48.4) were associated with candidaemia.
CONCLUSIONS: In haematology patients with fever during neutropenia, hypocitrullinaemia at fever onset was associated with candidaemia, but not with bacterial MBI-LCBI. Patients with intensive chemotherapy with a low MASCC-score and colonisation with Pichia kudriavzevii had the highest risk of MBI-LCBI.
BACKGROUND: ClinicalTrials.gov (NCT02149329) at 19-NOV-2014.
摘要：
目的：高风险中性粒细胞减少症的血液病患者容易发生粘膜屏障损伤相关的实验室确诊血流感染（MBI-LCBI）。我们评估了MBI-LCBI的危险因素，包括发热的中性粒细胞减少性血液病患者的念珠菌血症。
方法：这项前瞻性观察性研究在荷兰的六个专门血液科进行。符合条件的血液科患者中性粒细胞减少<500/mL，持续≥7天，并且发烧。根据疾病控制中心(CDC)定义对MBI-LCBI进行分类,并跟踪直到中性粒细胞减少症>500/mL或出院结束。
结果：我们纳入了2014年12月至2019年8月的416例患者。我们观察到63MBI-LCBI。临床粘膜炎评分和发热时的瓜氨酸血药浓度均与MBI-LCBI无关。在多变量分析中，MASCC得分（赔率比[OR]1.16，95%置信区间[CI]每减1点1.05至1.29），强化化疗（OR3·81，95％CI2.10至6.90）和毕赤酵母（以前的念珠菌）定植（OR5.40，95％CI1.75至16.7）保留为MBI-LCBI的危险因素，而喹诺酮的使用似乎具有保护作用（OR0.42，95％CI0.20至0.92）。瓜氨酸水平（每µmol/L降低1.57，95%CI1.07至2.31），活动性慢性阻塞性肺疾病(OR15.4,95%CI1.61~14.7)和耐氟康唑念珠菌定植(OR8.54,95%CI1.51~48.4)与念珠菌血症相关.
结论：在中性粒细胞减少症期间发热的血液病患者中，发热时的低瓜氨酸血症与念珠菌血症相关,但不是细菌MBI-LCBI.低MASCC评分和毕赤酵母定植的强化化疗患者发生MBI-LCBI的风险最高。
背景：ClinicalTrials.gov（NCT02149329），2014年11月19日。
方法：这项前瞻性观察性研究在荷兰的六个专门血液科进行。符合条件的血液科患者中性粒细胞减少<500/mL，持续≥7天，并且发烧。根据疾病控制中心(CDC)定义对MBI-LCBI进行分类,并跟踪直到中性粒细胞减少症>500/mL或出院结束。
结果：我们纳入了2014年12月至2019年8月的416例患者。我们观察到63MBI-LCBI。临床粘膜炎评分和发热时的瓜氨酸血药浓度均与MBI-LCBI无关。在多变量分析中，MASCC得分（赔率比[OR]1.16，95%置信区间[CI]每减1点1.05至1.29），强化化疗（OR3·81，95％CI2.10至6.90）和毕赤酵母（以前的念珠菌）定植（OR5.40，95％CI1.75至16.7）保留为MBI-LCBI的危险因素，而喹诺酮的使用似乎具有保护作用（OR0.42，95％CI0.20至0.92）。瓜氨酸水平（每µmol/L降低1.57，95%CI1.07至2.31），活动性慢性阻塞性肺疾病(OR15.4,95%CI1.61~14.7)和耐氟康唑念珠菌定植(OR8.54,95%CI1.51~48.4)与念珠菌血症相关.
结论：在中性粒细胞减少症期间发热的血液病患者中，发热时的低瓜氨酸血症与念珠菌血症相关,但不是细菌MBI-LCBI.低MASCC评分和毕赤酵母定植的强化化疗患者发生MBI-LCBI的风险最高。
背景：ClinicalTrials.gov（NCT02149329），2014年11月19日。
