Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis
Abstract Background Epidemiology of infectious diseases causing febrile illness varies geographically with human attributes. Periodic institutional surveillance of clinical and microbiological profiles in adding data to updating trends, modulating pharmatherapeutics, signifying possible excessive tr...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08218-8 |
| _version_ | 1827966437672615936 |
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| author | Choi Wan Chan Alex Molassiotis Harold K. K. Lee |
| author_facet | Choi Wan Chan Alex Molassiotis Harold K. K. Lee |
| author_sort | Choi Wan Chan |
| collection | DOAJ |
| description | Abstract Background Epidemiology of infectious diseases causing febrile illness varies geographically with human attributes. Periodic institutional surveillance of clinical and microbiological profiles in adding data to updating trends, modulating pharmatherapeutics, signifying possible excessive treatments and risk of drug resistance in post-chemotherapy neutropenic fever (NF) in hematological malignancy (HM) is limited. We aimed to review institutional clinical and microbiological data and explore clinical phenotype pattern groups among data. Methods Available data from 372 NF episodes were included. Demographics, types of malignancies, laboratory data, antimicrobial treatments and febrile-related outcome data such as predominant pathogens and microbiological diagnosed infections (MDIs) were collected. Descriptive statistics, two-step cluster analysis and non-parametric tests were employed. Results The occurrences of microbiological diagnosed bacterial infections (MDBIs; 20.2%) and microbiological diagnosed fungal infections (MDFIs; 19.9%) were almost equal. Gram-negative pathogens (11.8%) were comparable with gram-positive pathogens (9.9%), with gram-negative being slightly predominant. Death rate was 7.5%. Two-step cluster analysis yielded four distinct clinical phenotype pattern (cluster) groups: cluster 1 ‘lymphomas without MDIs’, cluster 2 ‘acute leukemias MDBIs’, cluster 3 ‘acute leukemias MDFIs’ and cluster 4 ‘acute leukemias without MDIs’. Considerable NF events with antibiotic prophylaxis being not identified as MDI might have cases in low-risk with non-infectious reasons causing febrile reactions that might possibly not require prophylaxis. Conclusions Regular institutional surveillance with active parameter assessments to signify risk levels in the post-chemotherapy stage, even prior to the onset of fever, might be an evidence-based strategy in the management of NF in HM. |
| first_indexed | 2024-04-09T17:48:52Z |
| format | Article |
| id | doaj.art-0aee8dddf287494ca398a91fdf8440cb |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-09T17:48:52Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-0aee8dddf287494ca398a91fdf8440cb2023-04-16T11:07:50ZengBMCBMC Infectious Diseases1471-23342023-04-0123111410.1186/s12879-023-08218-8Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysisChoi Wan Chan0Alex Molassiotis1Harold K. K. Lee2School of Nursing, The Hong Kong Polytechnic UniversitySchool of Nursing, The Hong Kong Polytechnic UniversityDepartment of Medicine & Geriatrics, Princess Margaret HospitalAbstract Background Epidemiology of infectious diseases causing febrile illness varies geographically with human attributes. Periodic institutional surveillance of clinical and microbiological profiles in adding data to updating trends, modulating pharmatherapeutics, signifying possible excessive treatments and risk of drug resistance in post-chemotherapy neutropenic fever (NF) in hematological malignancy (HM) is limited. We aimed to review institutional clinical and microbiological data and explore clinical phenotype pattern groups among data. Methods Available data from 372 NF episodes were included. Demographics, types of malignancies, laboratory data, antimicrobial treatments and febrile-related outcome data such as predominant pathogens and microbiological diagnosed infections (MDIs) were collected. Descriptive statistics, two-step cluster analysis and non-parametric tests were employed. Results The occurrences of microbiological diagnosed bacterial infections (MDBIs; 20.2%) and microbiological diagnosed fungal infections (MDFIs; 19.9%) were almost equal. Gram-negative pathogens (11.8%) were comparable with gram-positive pathogens (9.9%), with gram-negative being slightly predominant. Death rate was 7.5%. Two-step cluster analysis yielded four distinct clinical phenotype pattern (cluster) groups: cluster 1 ‘lymphomas without MDIs’, cluster 2 ‘acute leukemias MDBIs’, cluster 3 ‘acute leukemias MDFIs’ and cluster 4 ‘acute leukemias without MDIs’. Considerable NF events with antibiotic prophylaxis being not identified as MDI might have cases in low-risk with non-infectious reasons causing febrile reactions that might possibly not require prophylaxis. Conclusions Regular institutional surveillance with active parameter assessments to signify risk levels in the post-chemotherapy stage, even prior to the onset of fever, might be an evidence-based strategy in the management of NF in HM.https://doi.org/10.1186/s12879-023-08218-8Post-chemotherapy neutropenic feverFebrile neutropeniaHematological malignancyClinical and microbiological profilesPhenotype patternTwo-step cluster analysis |
| spellingShingle | Choi Wan Chan Alex Molassiotis Harold K. K. Lee Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis BMC Infectious Diseases Post-chemotherapy neutropenic fever Febrile neutropenia Hematological malignancy Clinical and microbiological profiles Phenotype pattern Two-step cluster analysis |
| title | Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis |
| title_full | Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis |
| title_fullStr | Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis |
| title_full_unstemmed | Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis |
| title_short | Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis |
| title_sort | clinical and microbiological profiles in post chemotherapy neutropenic fever in hematological malignancy exploration of clinical phenotype patterns by two step cluster analysis |
| topic | Post-chemotherapy neutropenic fever Febrile neutropenia Hematological malignancy Clinical and microbiological profiles Phenotype pattern Two-step cluster analysis |
| url | https://doi.org/10.1186/s12879-023-08218-8 |
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