Burden, risk factors, and management of neutropenic fever among solid cancer patients in Ethiopia
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ABSTRACT: Objectives:
Although neutropenic fever is one of the most well-known oncologic
SUBMITTER: Agegnew Wondm S
PROVIDER: S-EPMC9130822 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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| S-EPMC10043746 | biostudies-literature
Project description:Invasive fungal diseases (IFDs) still represent a relevant cause of mortality in patients affected by hematological malignancies, especially acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) undergoing remission induction chemotherapy, and in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Mold-active antifungal prophylaxis (MAP) has been established as a standard of care. However, breakthrough IFDs (b-IFDs) have emerged as a significant issue, particularly invasive aspergillosis and non-Aspergillus invasive mold diseases. Here, we perform a narrative review, discussing the major advances of the last decade on prophylaxis, the diagnosis of and the treatment of IFDs in patients with high-risk neutropenic fever undergoing remission induction chemotherapy for AML/MDS and allo-HSCT. Then, we present our single-center retrospective experience on b-IFDs in 184 AML/MDS patients undergoing high-dose chemotherapy while receiving posaconazole (n = 153 induction treatments, n = 126 consolidation treatments, n = 60 salvage treatments). Six cases of probable/proven b-IFDs were recorded in six patients, with an overall incidence rate of 1.7% (6/339), which is in line with the literature focused on MAP with azoles. The incidence rates (IRs) of b-IFDs (95% confidence interval (95% CI), per 100 person years follow-up (PYFU)) were 5.04 (0.47, 14.45) in induction (n = 2), 3.25 (0.0013, 12.76) in consolidation (n = 1) and 18.38 (3.46, 45.06) in salvage chemotherapy (n = 3). Finally, we highlight the current challenges in the field of b-IFDs; these include the improvement of diagnoses, the expanding treatment landscape of AML with molecular targeted drugs (and related drug-drug interactions with azoles), evolving transplantation techniques (and their related impacts on IFDs' risk stratification), and new antifungals and their features (rezafungin and olorofim).
| S-EPMC10818361 | biostudies-literature
Project description:Early antibiotic discontinuation has been proposed in patients with hematologic malignancy with fever of unknown origin during febrile neutropenia (FN). We intended to investigate the safety of early antibiotic discontinuation in FN. Two reviewers independently searched for articles from Embase, CENTRAL, and MEDLINE on 30 September 2022. The selection criteria were randomized control trials (RCTs) comparing short- and long-term durations for FN in cancer patients, and evaluating mortality, clinical failure, and bacteremia. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. We identified eleven RCTs (comprising 1128 distinct patients with FN) from 1977 to 2022. A low certainty of evidence was observed, and no significant differences in mortality (RR 1.43, 95% CI, 0.81, 2.53, I2 = 0), clinical failure (RR 1.14, 95% CI, 0.86, 1.49, I2 = 25), or bacteremia (RR 1.32, 95% CI, 0.87, 2.01, I2 = 34) were identified, indicating that the efficacy of short-term treatment may not differ statistically from that of long-term treatment. Regarding patients with FN, our findings provide weak conclusions regarding the safety and efficacy of antimicrobial discontinuation prior to neutropenia resolution.
| S-EPMC10001032 | biostudies-literature
Project description:BackgroundNeutropenic fever (NF) is associated with significant morbidity and mortality for patients receiving cancer treatment in sub-Saharan Africa (sSA). However, the antibiotic management of NF in sub-Saharan Africa has not been well described. We evaluated the timing and selection of antibiotics for patients with NF at the Uganda Cancer Institute (UCI).MethodsWe conducted a retrospective chart review of adults with acute leukemia admitted to UCI from 1 January 2016 to 31 May 2017, who developed NF. For each NF event, we evaluated the association of clinical presentation and demographics with antibiotic selection as well as time to both initial and guideline-recommended antibiotics. We also evaluated the association between ordered antibiotics and the in-hospital case fatality ratio (CFR).ResultsForty-nine NF events occurred among 39 patients. The time to initial antibiotic order was <1 day. Guideline-recommended antibiotics were ordered for 37 (75%) NF events. The median time to guideline-recommended antibiotics was 3 days. Fever at admission, a documented physical examination, and abdominal abnormalities were associated with a shorter time to initial and guideline-recommended antibiotics. The in-hospital CFR was 43%. There was no difference in in-hospital mortality when guideline-recommended antibiotics were ordered as compared to when non-guideline or no antibiotics were ordered (hazard ratio, 0.51 [95% confidence interval {CI}, .10-2.64] and 0.78 [95% CI, .20-2.96], respectively).ConclusionsPatients with acute leukemia and NF had delayed initiation of guideline-recommended antibiotics and a high CFR. Prospective studies are needed to determine optimal NF management in sub-Saharan Africa, including choice of antibiotics and timing of antibiotic initiation.
| S-EPMC8275883 | biostudies-literature
Project description:Background: Effective management of solid waste, generated as a result of human activities, is crucial. However, improper solid waste management seriously threatens the environment and public health in developing countries including Ethiopia. Objective: This study is aimed at assessing the status of solid waste management practices and identifying key factors in Awi Administrative Zone, Ethiopia. Methods: A community-based cross-sectional study design was used to collect the data and then analyze using descriptive statistics and logistic regression modeling. The survey was conducted in select kebeles (wards) (administrative subdivisions) of Injibara, Dangila, and Chagni towns, using two-stage sampling techniques. Primary and secondary data sources were utilized. The per capita waste generation rate was calculated based on the total solid waste generated in kilograms per total family size of households per year. Results: The per capita per day solid waste generation rates for Injibara, Dangila, and Chagni were 0.443, 0.456, and 0.487 kg/capita/day, respectively. The composition of household solid waste mainly consisted of biodegradable and nonbiodegradable materials. It was concluded that a significant proportion of household solid waste comprised biodegradable organic matter, which could be efficiently recycled or decomposed through microbial activity. Of the households, 40.6% had access to door-to-door solid waste collection service, and 35.9% and 26.2% of the households disposed their solid waste on riverside bridge/drainage lines and roadside/open land, respectively. The regression analysis showed that the head of the household's age, family size, monthly income, solid waste selling practice, solid waste reduction practice, awareness of solid waste disposal rules, frequency of household cleanup campaign participation, and awareness of the impacts of improper solid waste management on the environment and human health were significantly associated with improper solid waste management practices. Conclusion: The study revealed poor performance in solid waste management in the study area, attributed to factors such as inadequate collection system design and schedule, open burning of refuse, substandard condition of the final dumpsite, and lack of community awareness leading to illegal dumping. Recommendations: Based on the findings of the study, we recommend that the town municipality strengthen its door-to-door solid waste collection service and distribution of communal bin containers, conduct environmental assessments for better dumpsite selection, and implement a community-based waste management system to ensure sustainable solutions and continuous education on proper solid waste management practices.
| S-EPMC11824480 | biostudies-literature
Project description:ObjectiveTo describe neutropenic fever management practices among healthcare institutions.DesignSurvey.ParticipantsMembers of the Society for Healthcare Epidemiology of America Research Network (SRN) representing healthcare institutions within the United States.MethodsAn electronic survey was distributed to SRN representatives, with questions pertaining to demographics, antimicrobial prophylaxis, supportive care, and neutropenic fever management. The survey was distributed from fall 2022 through spring 2023.Results40 complete responses were recorded (54.8% response rate), with respondent institutions accounting for approximately 15.7% of 2021 US hematologic malignancy hospitalizations and 14.9% of 2020 US bone marrow transplantations. Most entities have institutional guidelines for neutropenic fever management (35, 87.5%) and prophylaxis (31, 77.5%), and first-line treatment included IV antipseudomonal antibiotics (35, 87.5% cephalosporin; 5, 12.5% penicillin; 0, 0% carbapenem).We observed significant heterogeneity in treatment course decisions, with roughly half (18, 45.0%) of respondents continuing antibiotics until neutrophil recovery, while the remainder having criteria for de-escalation prior to neutrophil recovery. Respondents were more willing to de-escalate prior to neutrophil recovery in patients with identified clinical (27, 67.5% with pneumonia) or microbiological (30, 75.0% with bacteremia) sources after dedicated treatment courses.ConclusionsWe found substantial variation in the practice of de-escalation of empiric antibiotics relative to neutrophil recovery, highlighting a need for more robust evidence for and adoption of this practice. No respondents use carbapenems as first-line therapy, comparing favorably to prior survey studies conducted in other countries.
| S-EPMC11611503 | biostudies-literature
Project description:Despite antibiotic prophylaxis, most patients with acute leukemia receiving mucotoxic chemotherapy develop neutropenic fever (NF), many cases of which remain without a documented etiology. Antibiotics disrupt the gut microbiota, with adverse clinical consequences, such as Clostridioides difficile infection. A better understanding of NF pathogenesis could inform the development of novel therapeutics without deleterious effects on the microbiota. We hypothesized that metabolites absorbed from the gut to the bloodstream modulate pyrogenic and inflammatory pathways. Longitudinal profiling of the gut microbiota in 2 cohorts of patients with acute leukemia showed that Akkermansia expansion in the gut was associated with an increased risk for NF. As a prototype mucolytic genus, Akkermansia may influence the absorption of luminal metabolites; thus, its association with NF supported our metabolomics hypothesis. Longitudinal profiling of the serum metabolome identified a signature associated with gut Akkermansia and 1 with NF. Importantly, these 2 signatures overlapped in metabolites in the γ-glutamyl cycle, suggesting oxidative stress as a mediator involved in Akkermansia-related NF. In addition, the level of gut microbial-derived indole compounds increased after Akkermansia expansion and decreased before NF, suggesting their role in mediating the anti-inflammatory effects of Akkermansia, as seen predominantly in healthy individuals. These results suggest that Akkermansia regulates microbiota-host metabolic cross talk by modulating the mucosal interface. The clinical context, including factors influencing microbiota composition, determines the type of metabolites absorbed through the gut barrier and their net effect on the host. Our findings identify novel aspects of NF pathogenesis that could be targets for precision therapeutics. This trial was registered at www.clinicaltrials.gov as #NCT03316456.
| S-EPMC8945620 | biostudies-literature
Project description:Children with cancer and non-neutropenic fever (NNF) episodes are often treated as outpatients if they appear well. However, a small subset have bloodstream infections (BSIs) and must return for further evaluation. These patients may be directly admitted to inpatient units, whereas others are first evaluated in outpatient settings before admission. The best practice for securing care for patients discovered to have outpatient bacteremia are unclear. To determine outcomes and compare time to antibiotics between the 2 disposition, we retrospectively reviewed all NNF initially treated as outpatients and later had positive blood cultures from 2012 to 2016. Of 845 NNF cases initially treated in outpatient settings, 48 episodes (n=43 patients) had BSIs. Of those, 77.1% (n=37) were re-evaluated as outpatients and admitted; 14.6% (n=7) were direct admissions. The median time to antibiotic did not significantly differ between outpatient re-evaluations (119 min) and direct admissions (191 min), P=0.11. One patient met sepsis criteria upon return and required intensive care unit admission for vasopressor support. No patient died within 1 week of the febrile episode. Most patients with NNF and BSIs initially discharged are stable upon return. Institutions should evaluate their patient flows to ensure that patients receive timely care.
| S-EPMC7762736 | biostudies-literature
Project description:Rift Valley fever (RVF) is one of the emerging arthropod-borne zoonotic viral diseases with serious public and economic significance in the livestock and human populations of East Africa. Its epidemiology is inadequately recognized in Ethiopia. A cross-sectional study was conducted to investigate the seroprevalence and potential risk factors of RVF in domestic livestock of Amibara and Haruka districts of the Afar Region, northeastern Ethiopia. A total of 736 (224 cattle, 121 goats, 144 sheep, 155 camels and 92 donkeys) blood samples were collected, and serum extracted and tested using competitive ELISA. A questionnaire survey was used to assess potential risk factors of RVF infection. The overall seroprevalence was 22.0% (162/736; 95% CI: 19.41-24.79%). The seroprevalence was significantly higher in goats (42.2%, 95% CI: 39.61-44.99%) compared to that of cattle (14.3%, 95% CI: 11.74-17.09%), sheep (21.5%, 95% CI: 18.91-24.29%), or camels (30.97%, 95% CI: 28.38-33.76%) (P < 0.001). The study showed that seropositivity for IgG antibody to RVFV infection was associated with locality and species of animal. Goats were two times more likely to be seropositive for RVFV infection than cattle (OR: 2.3, 95% CI: 1.462-3.574, P = 0.001). Livestock in the Kealatburi area were five times more likely to be seropositive for RVFV infection than those in the Halidegei area (OR: 5.074, 95% CI: 3.066-8.396, P = 0.001). This study revealed that RVF is an important animal health problem in the Afar Region. Therefore, monitoring of RVF in animals, humans, and vectors along with community sensitization of high-risk populations could benefit mitigating the risk posed by the disease. Quarantine measures should be implemented to reduce the risk of RVFV introduction and dissemination among susceptible animals and ultimately transmission to humans.
| S-EPMC11525614 | biostudies-literature
Project description:Neutropenic fever (NF) is a common complication of chemotherapy in patients with cancer which often prolongs hospitalization and worsens the quality of life. Although an empiric antimicrobial approach is used to prevent and treat NF, a clear etiology cannot be found in most cases. Emerging data suggest an altered microbiota-host crosstalk leading to NF. We profiled the serum metabolome and gut microbiome in longitudinal samples before and after NF in patients with acute myeloid leukemia, a prototype setting with a high incidence of NF. We identified a circulating metabolomic shift after NF, with a minimal signature containing 18 metabolites, 13 of which were associated with the gut microbiota. Among these metabolites were markers of intestinal epithelial health and bacterial metabolites of dietary tryptophan with known anti-inflammatory and gut-protective effects. The level of these metabolites decreased after NF, in parallel with biologically consistent changes in the abundance of mucolytic and butyrogenic bacteria with known effects on the intestinal epithelium. Together, our findings indicate a metabolomic shift with NF which is primarily characterized by a loss of microbiota-derived protective metabolites rather than an increase in detrimental metabolites. This analysis suggests that the current antimicrobial approach to NF may need a revision to protect the commensal microbiota.
| S-EPMC9012881 | biostudies-literature