Outcome of Febrile Neutropenic Patients Treated for Bacteriuria in Hematology

Abstract IntroductionPositive urine sample is a frequent finding in post-chemotherapy febrile neutropenia (FN) and can lead to prolonged antibiotic therapy. The aim of this study was to assess the outcome of bacteriuria episodes in FN patients receiving targeted antibiotic therapy.Materials and methodsA multicentric retrospective study was conducted over a four-year period (2014-2019). All consecutive first bacteriuria episodes (≤2 bacteria with at least ≥103 CFU/mL) during FN in hospitalized adult patients for hematological malignancies were included. Relapse and recurrence were defined by fever or urinary tract symptoms (UTS) with the same bacterial subspecies in urine occurring ≤ 7 days and ≤30 days, respectively, after antibiotic discontinuation. Mortality rate was determined at 30 days. Targeted antibiotic therapy ≤10 days for women and ≤14 for men was considered as short course.ResultsAmong 97 patients, 105 episodes were analyzed; 67.6% occurred in women, 41.9% in AML patients, 17.1% were bacteremic, 14.2% presented with UTS, and 61.9% were treated with short-course antibiotic treatment. One death was reported. In men, no relapse/recurrence was noted, even in the short-course antibiotic group. In women, 2.8% of episodes treated with short-course antibiotic led to relapse or recurrence.ConclusionsRelapse, recurrence, and mortality were uncommon events in FN patients experiencing bacteriuria episode, whatever the antibiotic duration. To distinguish asymptomatic bacteriuria from infection remained challenging in women. In men, the withdrawal of systematic urinalysis at onset of FN could lead to insufficient bacteriuria diagnosis and treatment.