engleski

Characteristics of hematological patients with blood cultures proven sepsis - experience of one center

Background: Hematological patients are at higher risk for infections and their subsequent complications. Febrile neutropenia and sepsis are the main causes of non-selective mortality in patients with malignant hematological diseases. For adequate treatment, it is necessary to know the characteristics of the disease and the local microbiological situation. Patients with febrile neutropenia should be approached in accordance with the guidelines for management of sepsis with the aim of preventing the development of septic shock and possible death. Aims: To determine the risk factors for sepsis development in hematological patients, the type of cause and the outcome of the treatment. Methods: The available clinical, laboratory and microbiological data of hematological patients treated for sepsis at the Clinic for Internal Diseases, KB Merkur, were collected and analyzed from January 2013. until April 2017. Results: We analyzed 239 patients and 319 episodes of fever with positive blood cultures. Of these, 38.55% patiens had acute leukemia, 31.32% had non Hodgkin's lymphoma, 15.26% had multiple myeloma and 6.014% patients had Hodgkin's lymphom. Other 8.835% of all patients were treated for some other diagnoses (amyloidosis, myeloproliferative neoplasm, myelodisplastic syndrom, aplastic anemia, Langerhans cell histiocytosis). 14% patients had undergone autologous peripheral stem-cell transplantation. A total of 80.8% of the patients had an active disease while having sepsis. Neutropenic were 70.5% of the patients. The most common cause of neutropenia was intensive chemotherapy (52.5%). Other causes of neutropenia were: lower intensity chemotherapy (19.2%), bone marrow transplantation (18.5%) or untreated hematological disease (9.8%). The average duration of neutropenia was 12.4 days (median 9). The average duration of the fever was 5.71 days (median 5) for not transplanted patients and 4.29 days (median 6) for transplanted patients. More than half of the patients (59.8%) had a central venous route (CVK) at the moment of febrile illness. A total of 36 different agents were isolated, out of which 53% were gram negative. The most commonly isolated agents were E. coli (17.1%), K. pneumoniae (16.2%), coagulase negative staphylococci (14.1%) and P. aeruginosa (8.6%). There was no statistically significant difference in the frequency of gram positive or negative pathogens between patients who had CVK and those who did not. Total mortality was 29%. Most of the deaths (84.5%) had prolonged neutropenia due to intensive chemotherapy. In 60% of the cases, the cause of death was gram negative sepsis. Among the patients with active disease who died in sepsis the most common diagnosis were acute myeloid leukemia (34.9%) and non Hodgkin's lymphoma (30.2%). We found a statistically significant correlation between the mortality rate and the couse of neutropenia (p=0.002). Also, statistically significant correlation was found between the mortality rate and disease activity in patients with sepsis (p=0.001). No statistically significant association of mortality with the type of causative agent or with the presence of CVK was found. Conclusion: The analysis of our data showed a high mortality rate in hematological patients with sepsis, depending on the type and activity of the underlying disease which confirms the importance of an early and aggressive treatment of each infection in immunocompromised patients.

Febrile neutropenia, Risk factors, Sepsis

nije evidentirano