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Outcome of febrile neutropenic patients treated for bacteriuria in hematology

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Abstract

Introduction

Positive urine sample is a frequent finding in post-chemotherapy febrile neutropenia (FN) and can lead to prolonged antibiotic therapy. The aim of this study was to assess the outcome of bacteriuria episodes in FN patients receiving targeted antibiotic therapy.

Materials and methods

A multi-centric retrospective study was conducted over a four-year period (2014–2019) on systematic urinalysis. All consecutive first bacteriuria episodes (≤ 2 bacteria with at least ≥ 103 CFU/mL) during FN in hospitalized adult patients for hematological malignancies were included. Relapse and recurrence were defined by fever or urinary tract symptoms (UTS) with the same bacterial subspecies in urine occurring ≤ 7 days and ≤ 30 days, respectively, after antibiotic discontinuation. Mortality rate was determined at 30 days. Targeted antibiotic therapy ≤ 10 days for women and ≤ 14 for men was considered as short course.

Results

Among 97 patients, 105 bacteriuria episodes on systematic urinalysis were analyzed; 67.6% occurred in women, 41.9% in AML patients, 17.1% were bacteremic, 14.2% presented with UTS, and 61.9% were treated with short-course antibiotic treatment. One death was reported. In men, no relapse/recurrence was noted, even in the short-course antibiotic group. In women, 2.8% of episodes treated with short-course antibiotic led to relapse or recurrence.

Conclusions

Relapse, recurrence, and mortality were uncommon events in FN patients experiencing bacteriuria episode, whatever the antibiotic duration. To distinguish asymptomatic bacteriuria from infection remained challenging in women. In men, systematic urinalysis at onset of FN could be useful.

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Acknowledgements

We thank Dr Kevin Brunet, PharmD, PhD (Université de Poitiers) and Dr Marion Lacasse, MD (CHU de Tours) for helping us with data extraction and Jeffrey Arsham for editing the manuscript.

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Authors and Affiliations

  1. Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France

    Thomas Delaye, Maxime Vallée, France Roblot & Blandine Rammaert

  2. CHU de Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France

    Thomas Delaye, France Roblot & Blandine Rammaert

  3. CHU de Poitiers, Service d’Hématologie, Poitiers, France

    José Miguel Torregrosa Diaz & Maria Pilar Gallego Hernanz

  4. CHU de Poitiers, Service de Chirurgie Urologique et de Transplantations Rénales, Poitiers, France

    Maxime Vallée

  5. INSERM U1070, Poitiers, France

    Maxime Vallée, France Roblot & Blandine Rammaert

  6. CHU de Tours, Service d’Hématologie Et Thérapie Cellulaire, Equipe LNOx CNRS ERL 7001, Tours, France

    Emmanuel Gyan

  7. CHU de Tours, Service de Bactériologie Département des Agents Infectieux Tours, Poitiers, France

    Philippe Lanotte

  8. Service de Médecine Interne et Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, CS 90577, Cedex, 86021, Poitiers, France

    Blandine Rammaert

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  1. Thomas Delaye
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Contributions

TD, BR, and JT conceived and designed the study; TD and PL collected the data; TD and JT contributed data analysis; TD, BR, JT, PG, PL, FR, and MV performed the analysis; all authors contributed to manuscript preparation, reviewed the results, and approved the final version of the manuscript.

Corresponding author

Correspondence to Blandine Rammaert.

Ethics declarations

Ethics approval

The National Data Protection Authority (Commission Nationale Informatique et Libertés), which is responsible for the protection of individual data in France, approved the panel and its procedures. The protocol was registered as CHU86-R2019-03–01.

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Not applicable.

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Not applicable.

Conflict of interest

Blandine Rammaert has conflicts outside the submitted work: travel grants from Pfizer and MSD, speaker’s fees from MSD, Gilead, Astellas, Iqone. Emmanuel Gyan has conflicts outside the submitted work: research funding from Novartis and BMS, consulting fees from Novartis, Abbvie, Incyte, Jazz Pharmaceutical, support for travel from Gilead, Sanofi, speaker’s fees from Novartis. Other authors declare no competing interests.

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Delaye, T., Torregrosa Diaz, J.M., Vallée, M. et al. Outcome of febrile neutropenic patients treated for bacteriuria in hematology. Support Care Cancer 31, 102 (2023). https://doi.org/10.1007/s00520-022-07522-4

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