Molekularna dijagnostika bakterijemije i fungemije u bolesnika s febrilnom neutropenijom i malignom bolesti [Molecular diagnostics of bacteremia and fungemia in patients with febrile neutropenia and malignant disease]

Herceg, Davorin (2016) Molekularna dijagnostika bakterijemije i fungemije u bolesnika s febrilnom neutropenijom i malignom bolesti [Molecular diagnostics of bacteremia and fungemia in patients with febrile neutropenia and malignant disease]. PhD thesis, Sveučilište u Zagrebu.

PDF Download (814kB)

Abstract

Febrile neutropenia (FN) is one of the most common oncological emergencies with significant risk of mortality. Nonetheless, patients are treated with broad-spectrum antimicrobial agens in hospital conditions and despite of other therapeutical measures, reported mortality was approximately 10%. Although the conduction of the treatment in the hospital environment is efficient, not all FN patients require intensive treatment, and this practise has been debated. Currently, the most used model of prediction of complication of FN is the MASCC risk-index score.This study was designed to validate the MASCC score in an attempt to accurately predict the FN complication risk. Furthermore, the detection of microbiological pathogen becomes a central point in management of FN and the one of the aim of the study was also to evaluate the usefulness of the multiplex blood PCR or SeptiFast test in the diagnosis of bloodstream infections in FN patients. ROC analasys in this study shows that the SeptiFast can not replace blood cultures in the diagnostic workup of FN. On the other hand the MASCC score can successfully discriminate the FN patients with low risk of complications and adding the procalcitonin adding to the MASCC risk-index score could improve risk stratification.

Abstract in Croatian

Neutropenijska vrućica (febrilna neutropenija-FN) je jedno o najučestalijih onkoloških hitnih stanja i predstavlja i značajan rizik mortaliteta. Usprkos liječenju s antibioticima širokog spektra u bolničkim uvjetima te drugim terapijskim mjerama smrtnost dosiže oko 10%. Premda je hospitalizacija kod FN uobičajen postupak, predmet je istraživanja, koji bolesnici ipak ne bi trebali biti hospitalizirani. Najsnažnije je prihvaćen MASCC indeks rizika, pomoću kojeg bi trebalo moći predvidjeti rizik komplikacija FN. Nadalje, dokazivanje mikrobiološkog uzočnika FN postaje središnje mjesto u obradi i liječenju FN, te je jedna od svrha rada bila evaluirati korist od upotrebe multiplex PCR testa-SeptiFast-a u dijagnostici bakterijemije kod bolesnika s FN. ROC analiza u ovom radu pokazala je da u mikrobiološkoj obradi FN, SeptiFast ne može zamijeniti standardne hemokulture. S druge strane, MASCC indeks rizika pokazao se u u ovom radu uspješnim u razlikovanju bolesnika s FN i s niskim rizikom od komplikacija od onih sa visokim rizikom od komplikacija. Dodavanjem prokalcitonina MASCC-u poboljšava se stratifikacija bolesnika s povoljnim od onih s nepovoljnim ishodom FN.

Actions (login required)

View Item

Downloads