Bloodstream infections in neutropenic patients: early detection of pathogens and directed antimicrobial therapy due to surveillance blood cultures.
Bloodstream infections (BSIs) are frequent infectious complications in neutropenic patients. In order to determine the efficacy of surveillance blood cultures (BCs) to detect BSIs prior to clinical manifestation we performed a prospective trial. One hundred patients with haematological malignancies and long-term neutropenia following intensive cytotoxic therapies were recruited. BCs were taken thrice weekly during neutropenia. Forty-two patients were diagnosed with BSI. In 18 (43%) of those patients surveillance BC results were positive and identified microorganisms prior to onset of fever. In patients with positive surveillance BCs modification of the clinical management (specific antimicrobial therapy, CVC removal) resulted in a shorter time to defervescence (median 1.5 days) compared with patients with BCs positive after onset of fever (median 3.5 days, P = 0.004). In conclusion we detected causative microorganisms in more than one-third of BSIs prior to onset of clinical manifestation. The impact of surveillance BCs on the outcome has to be assessed in randomized studies.
Penack
O
O
Department of Haematology, Oncology, and Transfusion Medicine, Campus Benjamin Franklin, Charité, University of Medicine, Berlin, Germany. penacko@mskcc.org
Rempf
P
P
Eisenblätter
M
M
Stroux
A
A
Wagner
J
J
Thiel
E
E
Blau
I W
IW
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001769:Blood / Q000382:microbiology*; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009503:Neutropenia / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome