Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Neutropenia*/microbiology ; Bacterial Infections*/drug therapy ; Hematologic Neoplasms*/complications ; Hematologic Neoplasms*/drug therapy ; Hematologic Neoplasms*/microbiology ; Leukemia*/drug therapy; Humans ; Fever/microbiology ; Anti-Bacterial Agents/therapeutic use

Background: Epidemiology of infectious diseases causing febrile illness varies geographically with human attributes. Periodic institutional surveillance of clinical and microbiological profiles in adding data to updating trends, modulating pharmatherapeutics, signifying possible excessive treatments and risk of drug resistance in post-chemotherapy neutropenic fever (NF) in hematological malignancy (HM) is limited. We aimed to review institutional clinical and microbiological data and explore clinical phenotype pattern groups among data.
Methods: Available data from 372 NF episodes were included. Demographics, types of malignancies, laboratory data, antimicrobial treatments and febrile-related outcome data such as predominant pathogens and microbiological diagnosed infections (MDIs) were collected. Descriptive statistics, two-step cluster analysis and non-parametric tests were employed.
Results: The occurrences of microbiological diagnosed bacterial infections (MDBIs; 20.2%) and microbiological diagnosed fungal infections (MDFIs; 19.9%) were almost equal. Gram-negative pathogens (11.8%) were comparable with gram-positive pathogens (9.9%), with gram-negative being slightly predominant. Death rate was 7.5%. Two-step cluster analysis yielded four distinct clinical phenotype pattern (cluster) groups: cluster 1 'lymphomas without MDIs', cluster 2 'acute leukemias MDBIs', cluster 3 'acute leukemias MDFIs' and cluster 4 'acute leukemias without MDIs'. Considerable NF events with antibiotic prophylaxis being not identified as MDI might have cases in low-risk with non-infectious reasons causing febrile reactions that might possibly not require prophylaxis.
Conclusions: Regular institutional surveillance with active parameter assessments to signify risk levels in the post-chemotherapy stage, even prior to the onset of fever, might be an evidence-based strategy in the management of NF in HM.
(© 2023. The Author(s).)

South Asian J Cancer. 2017 Jan-Mar;6(1):25-27. (PMID: 28413792)
Nature. 2008 Feb 21;451(7181):990-3. (PMID: 18288193)
Support Care Cancer. 2005 Nov;13(11):870-7. (PMID: 15864658)
Br J Haematol. 2011 Jun;153(6):681-97. (PMID: 21504422)
J Infect. 2018 Jan;76(1):20-37. (PMID: 29079323)
Eur J Clin Microbiol Infect Dis. 2005 Jan;24(1):17-22. (PMID: 15660255)
J Clin Oncol. 2013 Feb 20;31(6):794-810. (PMID: 23319691)
J Clin Oncol. 2000 Aug;18(16):3038-51. (PMID: 10944139)
Asia Pac J Public Health. 2015 Apr;27(3):293-302. (PMID: 25296668)
Eur J Cancer Care (Engl). 2007 Nov;16(6):475-83. (PMID: 17944761)
Eur J Clin Microbiol Infect Dis. 2004 Mar;23(3):163-7. (PMID: 14986159)
JAMA. 2016 Sep 20;316(11):1193-1204. (PMID: 27654605)
J Clin Microbiol. 2013 Nov;51(11):3478-83. (PMID: 23850953)
J Pain Symptom Manage. 2020 Jun;59(6):1204-1211. (PMID: 31887406)
J Oncol. 2015;2015:596504. (PMID: 26290665)
J Lab Physicians. 2015 Jul-Dec;7(2):116-20. (PMID: 26417163)
Cancer. 2006 Oct 15;107(8):1743-51. (PMID: 16977651)
Support Care Cancer. 2013 May;21(5):1487-95. (PMID: 23443617)
Am J Infect Control. 2005 Aug;33(6):326-32. (PMID: 16061138)
Clin Infect Dis. 2001 Apr 15;32(8):1162-71. (PMID: 11283805)
J Clin Oncol. 2018 Oct 20;36(30):3043-3054. (PMID: 30179565)
J Diabetes Investig. 2016 Mar;7(2):219-25. (PMID: 27042274)
Am J Hematol. 2020 Jul;95(7):792-798. (PMID: 32242967)
Support Care Cancer. 2011 Oct;19(10):1625-35. (PMID: 20820815)
Indian J Med Paediatr Oncol. 2016 Jul-Sep;37(3):174-82. (PMID: 27688611)
Indian J Med Paediatr Oncol. 2013 Apr;34(2):85-8. (PMID: 24049293)
Clin Infect Dis. 2004 Jul 15;39 Suppl 1:S32-7. (PMID: 15250018)
Virulence. 2016 Apr 2;7(3):280-97. (PMID: 27002635)
J Consult Clin Psychol. 1980 Aug;48(4):456-9. (PMID: 7400430)
N Engl J Med. 2005 Sep 8;353(10):977-87. (PMID: 16148283)

1-ZE81 hong kong polytechnic university block grant

Keywords: Clinical and microbiological profiles; Febrile neutropenia; Hematological malignancy; Phenotype pattern; Post-chemotherapy neutropenic fever; Two-step cluster analysis

0 (Anti-Bacterial Agents)

Date Created: 20230413 Date Completed: 20230417 Latest Revision: 20230417

20231215

PMC10103375

10.1186/s12879-023-08218-8

37055745