BREAKTHROUGH BACTEREMIA DURING PROLONGED FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGIC MALIGNANCIES: INCIDENCE, RISK FACTORS, MICROBIOLOGICAL PROFILE AND CLINICAL OUTCOMES
- 1Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
Abstract
Introduction: Routine repeat blood cultures during persistent febrile neutropenia (FN) remain the standard of care despite recent studies demonstrating their low diagnostic yield in clinically stable patients. However, whether breakthrough bacteremia represents a distinct clinical entity remains unclear. We investigated its epidemiology, predictors, and clinical impact in adults with hematologic malignancies. Methods: We conducted a retrospective cohort study of adults with febrile neutropenia lasting >3 days at a Brazilian tertiary center (2015–2024). Breakthrough bacteremia was defined as a new clinically significant bloodstream infection occurring after FN day 3. Multivariable logistic regression identified risk factors, and Cox regression evaluated its association with 30-day mortality. Results: Among 460 FN episodes, breakthrough bacteremia occurred in 51 (11.1%). Independent predictors were acute myeloid leukemia (OR=2.56, p=0.007), central venous catheter use (OR=3.46, p=0.016), and longer hospitalization before FN onset (OR=1.12, p=0.010). Breakthrough bacteremia was associated with higher rates of antimicrobial modification (64.7% vs. 33.0%), septic shock (21.7% vs. 6.1%), and 30-day mortality (31.4% vs. 9.6%) (all p≤0.001). In time-dependent Cox analysis, breakthrough bacteremia remained independently associated with increased 30-day mortality (adjusted HR=2.90, 95% CI 1.41–5.99; p=0.004). Discussion: Although breakthrough bacteremia occurred in only one out of every nine prolonged FN episodes, affected patients represented a distinct subgroup characterized by substantially worse clinical outcome. These findings suggest that the clinical value of repeat blood cultures depends on appropriate patient selection rather than universal testing. Conclusions: Breakthrough bacteremia is a clinically significant complication of prolonged FN. Acute myeloid leukemia, central venous catheter use, and prolonged hospitalization identify patients at increased risk. Risk-adapted diagnostic strategies may optimize blood culture stewardship while preserving timely diagnosis of clinically important bloodstream infections.
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BibTeX
@article{cuquetto2026breakthrough,
title = {{BREAKTHROUGH BACTEREMIA DURING PROLONGED FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGIC MALIGNANCIES: INCIDENCE, RISK FACTORS, MICROBIOLOGICAL PROFILE AND CLINICAL OUTCOMES}},
author = {Gustavo Monteiro CUQUETTO and Luiza Falcão NANO and Simone Aranha NÓUER and Marcio NUCCI},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.106774},
url = {https://doi.org/10.1016/j.htct.2026.106774},
note = {CC BY},
}
RIS
TY - JOUR
TI - BREAKTHROUGH BACTEREMIA DURING PROLONGED FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGIC MALIGNANCIES: INCIDENCE, RISK FACTORS, MICROBIOLOGICAL PROFILE AND CLINICAL OUTCOMES
AU - Gustavo Monteiro CUQUETTO
AU - Luiza Falcão NANO
AU - Simone Aranha NÓUER
AU - Marcio NUCCI
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.106774
UR - https://doi.org/10.1016/j.htct.2026.106774
AB - Introduction: Routine repeat blood cultures during persistent febrile neutropenia (FN) remain the standard of care despite recent studies demonstrating their low diagnostic yield in clinically stable patients. However, whether breakthrough bacteremia represents a distinct clinical entity remains unclear. We investigated its epidemiology, predictors, and clinical impact in adults with hematologic malignancies. Methods: We conducted a retrospective cohort study of adults with febrile neutropenia lasting >3 days at a Brazilian tertiary center (2015–2024). Breakthrough bacteremia was defined as a new clinically significant bloodstream infection occurring after FN day 3. Multivariable logistic regression identified risk factors, and Cox regression evaluated its association with 30-day mortality. Results: Among 460 FN episodes, breakthrough bacteremia occurred in 51 (11.1%). Independent predictors were acute myeloid leukemia (OR=2.56, p=0.007), central venous catheter use (OR=3.46, p=0.016), and longer hospitalization before FN onset (OR=1.12, p=0.010). Breakthrough bacteremia was associated with higher rates of antimicrobial modification (64.7% vs. 33.0%), septic shock (21.7% vs. 6.1%), and 30-day mortality (31.4% vs. 9.6%) (all p≤0.001). In time-dependent Cox analysis, breakthrough bacteremia remained independently associated with increased 30-day mortality (adjusted HR=2.90, 95% CI 1.41–5.99; p=0.004). Discussion: Although breakthrough bacteremia occurred in only one out of every nine prolonged FN episodes, affected patients represented a distinct subgroup characterized by substantially worse clinical outcome. These findings suggest that the clinical value of repeat blood cultures depends on appropriate patient selection rather than universal testing. Conclusions: Breakthrough bacteremia is a clinically significant complication of prolonged FN. Acute myeloid leukemia, central venous catheter use, and prolonged hospitalization identify patients at increased risk. Risk-adapted diagnostic strategies may optimize blood culture stewardship while preserving timely diagnosis of clinically important bloodstream infections.
SN - 2531-1379
SN - 2531-1387
ER -