Urine cultures at the onset of febrile neutropenia rarely impact antibiotic management in asymptomatic adult cancer patients
Urine cultures at the onset of febrile neutropenia rarely impact antibiotic management in asymptomatic adult cancer patients
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DOI：
10.1007/s00520-018-4476-7
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发表时间：
2019-04-01
影响因子：
3.1
通讯作者：
Grigg, Andrew
中科院分区：
文献类型：
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作者：
Grigg, Sam E.;Date, Patrick;Grigg, Andrew
目的对于患有发热性中性粒细胞减少症 (FN) 且没有泌尿系统症状且接受治疗方案抗生素治疗的成人患者进行常规尿培养的效用，目前还缺乏相关数据。国际和区域 FN 指南中的建议不一致就反映了这一点。我们通过回顾性审查尿常规培养对三级医院血液科癌症住院患者抗生素管理的影响来解决这个问题。方法对 5 年期间（2011-2015）的所有血液科住院患者进行 FN 发作回顾性检查（中性粒细胞计数 37.5 摄氏度）。对于每次发作，收集人口统计数据、尿路症状和体征（无症状称为“无症状”）、尿液分析和尿培养结果、抗生素治疗和持续时间以及患者结果。如果检测到 >10(5) 菌落形成单位 (CFU)/L，则认为尿培养呈阳性。 FN 的经验性抗生素治疗包括稳定患者静脉注射哌拉西林/他唑巴坦，如果全身受损则添加万古霉素和单剂量庆大霉素。结果在 317 名患者中发现了 433 次 FN 发作。共进行了 362 次（84%）尿液培养。 48 次有症状发作中的 9 次 (19%) 培养结果呈阳性，而 314 次无症状发作中的 8 次 (2.5%) 培养结果呈阳性（RR = 7.4，p
PurposeThere is a paucity of data regarding the utility of routine urine cultures in adults with febrile neutropenia (FN) without urinary symptoms receiving protocolised antibiotics. This is reflected by inconsistent recommendations in international and regional FN guidelines. We addressed this issue by retrospectively reviewing the impact of routine urine cultures on antibiotic management in haematology cancer inpatients at a tertiary hospital.MethodsAll haematology inpatients over a 5-year period (2011-2015) were retrospectively reviewed for episodes of FN (neutrophil count 37.5 degrees C). For each episode, demographic data, urinary tract symptoms and signs (absence of which was termed asymptomatic'), urinalysis and urine culture results, antibiotic therapy and duration, and patient outcomes were collected. A urine culture was considered positive if >10(5) colony forming units (CFU)/L were detected. Empiric antibiotic therapy for FN consisted of intravenous piperacillin/tazobactam in stable patients, with the addition of vancomycin and a single dose of gentamicin if systemically compromised.ResultsFour hundred and thirty-three episodes of FN were identified in 317 patients. Urine cultures were performed in 362 (84%) episodes. Cultures were positive in 9 of 48 (19%) symptomatic episodes versus 8 of 314 (2.5%) asymptomatic episodes (RR =7.4, p