Etiology of Fever and Associated Outcomes Among Adults Receiving Chemotherapy for the Treatment of Solid Tumors in Uganda.
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
01
06
2023
accepted:
11
10
2023
medline:
13
11
2023
pubmed:
13
11
2023
entrez:
13
11
2023
Statut:
epublish
Résumé
Little is known about the microbiology and outcomes of chemotherapy-associated febrile illness among patients in sub-Saharan Africa. Understanding the microbiology of febrile illness could improve antibiotic selection and infection-related outcomes. From September 2019 through June 2022, we prospectively enrolled adult inpatients at the Uganda Cancer Institute who had solid tumors and developed fever within 30 days of receiving chemotherapy. Evaluation included blood cultures, malaria rapid diagnostic tests, and urinary lipoarabinomannan testing for tuberculosis. Serum cryptococcal antigen was evaluated in participants with human immunodeficiency virus (HIV). The primary outcome was the mortality rate 40 days after fever onset, which we estimated using Cox proportional hazards models. A total of 104 febrile episodes occurred among 99 participants. Thirty febrile episodes (29%) had ≥1 positive microbiologic result. The most frequently identified causes of infection were tuberculosis (19%) and bacteremia (12%). The prevalence of tuberculosis did not differ by HIV status. The 40-day case fatality ratio was 25%. There was no difference in all-cause mortality based on HIV serostatus, presence of neutropenia, or positive microbiologic results. A universal vital assessment score of >4 was associated with all-cause mortality (hazard ratio, 14.5 [95% confidence interval, 5-42.7]). The 40-day mortality rate among Ugandan patients with solid tumors who developed chemotherapy-associated febrile illness was high, and few had an identified source of infection. Tuberculosis and bacterial bloodstream infections were the leading diagnoses associated with fever. Tuberculosis should be included in the differential diagnosis for patients who develop fever after receiving chemotherapy in tuberculosis-endemic settings, regardless of HIV serostatus.
Sections du résumé
Background
UNASSIGNED
Little is known about the microbiology and outcomes of chemotherapy-associated febrile illness among patients in sub-Saharan Africa. Understanding the microbiology of febrile illness could improve antibiotic selection and infection-related outcomes.
Methods
UNASSIGNED
From September 2019 through June 2022, we prospectively enrolled adult inpatients at the Uganda Cancer Institute who had solid tumors and developed fever within 30 days of receiving chemotherapy. Evaluation included blood cultures, malaria rapid diagnostic tests, and urinary lipoarabinomannan testing for tuberculosis. Serum cryptococcal antigen was evaluated in participants with human immunodeficiency virus (HIV). The primary outcome was the mortality rate 40 days after fever onset, which we estimated using Cox proportional hazards models.
Results
UNASSIGNED
A total of 104 febrile episodes occurred among 99 participants. Thirty febrile episodes (29%) had ≥1 positive microbiologic result. The most frequently identified causes of infection were tuberculosis (19%) and bacteremia (12%). The prevalence of tuberculosis did not differ by HIV status. The 40-day case fatality ratio was 25%. There was no difference in all-cause mortality based on HIV serostatus, presence of neutropenia, or positive microbiologic results. A universal vital assessment score of >4 was associated with all-cause mortality (hazard ratio, 14.5 [95% confidence interval, 5-42.7]).
Conclusions
UNASSIGNED
The 40-day mortality rate among Ugandan patients with solid tumors who developed chemotherapy-associated febrile illness was high, and few had an identified source of infection. Tuberculosis and bacterial bloodstream infections were the leading diagnoses associated with fever. Tuberculosis should be included in the differential diagnosis for patients who develop fever after receiving chemotherapy in tuberculosis-endemic settings, regardless of HIV serostatus.
Identifiants
pubmed: 37953812
doi: 10.1093/ofid/ofad508
pii: ofad508
pmc: PMC10633783
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofad508Subventions
Organisme : NCI NIH HHS
ID : P30 CA015704
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA044579
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI150508
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI118690
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI007046
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
Organisme : FIC NIH HHS
ID : D43 TW009345
Pays : United States
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Déclaration de conflit d'intérêts
Potential conflicts of interest. All authors: No reported conflicts.
Références
PLoS Med. 2020 May 1;17(5):e1003113
pubmed: 32357197
Haematologica. 2013 Dec;98(12):1826-35
pubmed: 24323983
Int J Infect Dis. 2017 Jun;59:96-102
pubmed: 28457751
PLoS One. 2009 Nov 11;4(11):e7782
pubmed: 19907656
Clin Infect Dis. 2011 Feb 15;52(4):e56-93
pubmed: 21258094
Front Med (Lausanne). 2019 Jun 18;6:131
pubmed: 31275940
BMJ Glob Health. 2017 Jul 28;2(2):e000344
pubmed: 29082001
Int J Tuberc Lung Dis. 2015 Oct;19(10):1128-34
pubmed: 26459522
Int J Cancer. 2010 Dec 15;127(12):2893-917
pubmed: 21351269
J Clin Microbiol. 2007 Nov;45(11):3546-8
pubmed: 17881544
Lancet Infect Dis. 2010 Jun;10(6):417-32
pubmed: 20510282
J Glob Oncol. 2018 Sep;4:1-10
pubmed: 30241139
Med Mal Infect. 2015 Sep;45(9):374-82
pubmed: 26433872
Respirology. 2008 May;13(3):413-9
pubmed: 18399865
Antimicrob Agents Chemother. 2019 Dec 20;64(1):
pubmed: 31636071
Int J Mycobacteriol. 2015 Dec;4(4):337-40
pubmed: 26964818
Sci Rep. 2019 Aug 15;9(1):11901
pubmed: 31417132
Clin Microbiol Infect. 2018 Aug;24(8):808-814
pubmed: 29454844
Infect Ecol Epidemiol. 2014 Mar 13;4:
pubmed: 24765249
PLoS One. 2019 May 14;14(5):e0216060
pubmed: 31086371
J Clin Med. 2019 Dec 31;9(1):
pubmed: 31906163
PLoS One. 2018 Jun 28;13(6):e0199531
pubmed: 29953464
BMC Res Notes. 2019 Jul 30;12(1):464
pubmed: 31362783
Clin Infect Dis. 2004 Jun 15;38(12):1724-30
pubmed: 15227618
Crit Care. 2019 Jun 11;23(1):212
pubmed: 31186062
Medicine (Baltimore). 2018 Jul;97(30):e11592
pubmed: 30045290
Clin Microbiol Infect. 2012 Mar;18(3):268-81
pubmed: 21793988
Open Forum Infect Dis. 2021 Jun 10;8(7):ofab307
pubmed: 34262989
S Afr Med J. 2017 Jun 30;107(7):595-601
pubmed: 29025449
Ann Hematol. 2018 Nov;97(11):2225-2234
pubmed: 29974230
Eur Respir J. 2017 Aug 24;50(2):
pubmed: 28838977
Clin Infect Dis. 2019 Jan 7;68(2):266-272
pubmed: 29868873
Open Forum Infect Dis. 2021 Jul 19;8(8):ofab389
pubmed: 34458394
Clin Infect Dis. 2016 Dec 16;64(5):635-644
pubmed: 27986665
Chest. 2005 Oct;128(4):2218-22
pubmed: 16236877
Microbiol Spectr. 2023 Feb 14;11(1):e0431222
pubmed: 36625651
J Korean Med Sci. 2012 Dec;27(12):1468-71
pubmed: 23255844
Microb Pathog. 2018 Jan;114:180-192
pubmed: 29196174
Eur Respir J. 2019 Sep 12;54(3):
pubmed: 31221810