Albasanz-Puig, AdaiaMontero, Maria MilagroGudiol, CarlotaIRONIC study group2022-11-242022-11-242022Albasanz-Puig A, Durà-Miralles X, Laporte-Amargós J, Mussetti A, Ruiz-Camps I, Puerta-Alcalde P, et al. Effect of combination antibiotic empirical therapy on mortality in neutropenic cancer patients with pseudomonas aeruginosa pneumonia. Microorganisms. 2022 Mar 29; 10(4): 733. DOI: 10.3390/microorganisms100407332076-2607http://hdl.handle.net/10230/54994To assess the effect of combination antibiotic empirical therapy on 30-day case-fatality rate in neutropenic cancer patients with Pseudomonas aeruginosa (PA) bacteremic pneumonia. This was a multinational, retrospective cohort study of neutropenic onco-hematological patients with PA bloodstream infection (BSI) (2006-2018). The effect of appropriate empirical combination therapy, appropriate monotherapy and inappropriate empirical antibiotic therapy [IEAT] on 30-day case-fatality was assessed only in patients with PA bacteremic pneumonia. Among 1017 PA BSI episodes, pneumonia was the source of BSI in 294 (28.9%). Among those, 52 (17.7%) were caused by a multidrug-resistant (MDR) strain and 68 (23.1%) received IEAT, mainly when the infection was caused by an MDR strain [38/52 (73.1%) vs. 30/242 (12.4%); p < 0.001]. The 30-day case-fatality rate was higher in patients with PA bacteremic pneumonia than in those with PA BSI from other sources (55.1% vs. 31.4%; p < 0.001). IEAT was associated with increased 30-day case-fatality (aHR 1.44 [95%CI 1.01-2.03]; p = 0.042), whereas the use of appropriate combination empirical treatment was independently associated with improved survival (aHR 0.46 [95%CI 0.27-0.78]; p = 0.004). Appropriate empirical monotherapy was not associated with improved overall survival (aHR 1.25 [95%CI 0.76-2.05]; p = 0.39). Combination antibiotic empirical therapy should be administered promptly in febrile neutropenic patients with suspected pneumonia as the source of infection.application/pdfengCopyright © 2022 by Albasanz-Puig A, Durà-Miralles X, Laporte-Amargós J, Mussetti A, Ruiz-Camps I, Puerta-Alcalde P, et al. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).info:eu-repo/semantics/articlehttp://dx.doi.org/10.3390/microorganisms10040733Pseudomonas aeruginosaBloodstream infectionNeutropeniaPneumoniaSeptic shockinfo:eu-repo/semantics/openAccess