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.
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。