Objectives. Febrile neutropenic cancer patients are at risk for development of serious infections, morbidity and mortality. The aim of this study was to determine the type and frequency of infections and to evaluate some prognostic risk factors.
Methods. 220 episodes of neutropenic fever in 177 cancer patients have been reviewed.
Results. Infections could be documented microbiologically in 38 (17.3%) episodes and suspected clinically in 29 (13.2%). The most common focus of infection was the lower respiratory tract (11.4%) followed by the urinary tract (6.4%). The most frequently isolated pathogen was Escherichia coli (31%) followed by Klebsiella pneumoniae (18%), Pseudomonas aeruginosa (13%) and Streptococcus pneumoniae (13%). The median durations of neutropenia and fever were 4 and 3 days, respectively. Mortality was seen in 25 patients (11.4%). Its rate was higher in documented infections except for non-bacteremic microbiologic infections in which no death was seen. Hypotension and shock were the most significant determinants of poor prognosis.
Conclusions. The management of these special patients should be given adequate attention and be considered important since the success of therapy depends on revealing of etiologic agents.
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- Empirical treatment of febrile neutropenia: evolution of current therapeutic approaches.Clin Infect Dis. 1997; 24: S256-S265
- Infections in the cancer patient.in: De Jr., V Hellman S Rosenberg S.A Cancer: Principles and Practice of Oncology. 5th edn. Lippincott-Raven, Philadelphia1997: 2659-2704
- Fever in the compromised host.Infect Dis Clin North Am. 1996; 10: 129-148
- Fever in the neutropenic host.Infect Dis Clin North Am. 1996; 10: 777-795
- Management of fever in patients with cancer and treatment-induced neutropenia.N Engl J Med. 1993; 328: 1323-1332
- Infections in the immunocompromised host: general principles.in: Mandell G.L Bennett J.E Dolin R Principles and Practice of Infectious Diseases. 5th edn. Churchill Livingstone, Philadelphia2000: 3079-3090
- Pathogen ‘shift’ in febrile neutropenia.Curr Opin Infect Dis. 1999; 12: 351-354
- Guidelines for the use of antimicrobial agents in neutropenic patients with cancer.Clin Infect Dis. 2002; 34: 730-751
- Etiology of bacterial infections in cancer patients in Europe: an ever changing scenario (12th ECCMID, Milan-Italy, 21–24 April Abstract no: S344).Clin Microbiol Infect. 2002; 8: 50
- Pseudomonas aeruginosa—still a frequent pathogen in patients with cancer: 11-year experience at a comprehensive cancer center.Clin Infect Dis. 1999; 29: 463-464
- Planned progressive antimicrobial therapy in neutropenic patients.Br J Haematol. 1998; 102: 879-888
- The changing epidemiology of bacteremia in neutropenic children with cancer.Pediatr Infect Dis J. 1995; 14: 140-143
- Fever in immunocompromised patients.N Engl J Med. 1999; 341: 893-900
- New strategies in the treatment of infectious complications in haematology and oncology: is there a role for out-patient antibiotic treatment of febrile neutropenia?.Chemotherapy. 1998; 44: 424-435
- Early empiric antibiotic therapy for febrile neutropenia patients at low risk.Infect Dis Clin North Am. 1996; 10: 223-237
- “Low-risk” prediction rule for pediatric oncology patients presenting with fever and neutropenia.J Clin Oncol. 2000; 18: 1012-1019
- Pulmonary infiltrates in the cancer patient.Infect Dis Clin North Am. 1996; 10: 297-325
- Infectious complications of patients undergoing therapy for acute leukemia: current status and future prospects.Semin Oncol. 1997; 24: 132-140
- Pneumonia in the compromised host including cancer patients and transplant patients.Infect Dis Clin North Am. 1998; 12: 781-805
- Infectious complications in the critically ill patient with cancer.Semin Oncol. 2000; 27: 335-346
- Comparison of meropenem with amikacin plus ceftazidime in the empirical treatment of febrile neutropenia: a prospective multicentre trial in patients without previous prophylactic antibiotics.Int J Antimicrob Agents. 1999; 13: 15-19
- Comparison of cefepime and ceftazidime in combination with amikacin in the empirical treatment of high-risk patients with febrile neutropenia: a prospective, randomised, multicenter study.Scand J Infect Dis. 2001; 33: 827-831
- Empirical and subsequent use of antibacterial agents in the febrile neutropenic patient.J Intern Med. 1997; 740: 69-77
- Quantitive relationships between circulating leukocytes and infection in patients with acute leukemia.Ann Intern Med. 1966; 64: 328-340
- Fever in pediatric and young adult patient with cancer. A prospective study of 1001 episodes.Medicine (Baltimore). 1982; 61: 153-165
- The medical course of cancer patients with fever and neutropenia. Clinical identification of a low-risk subgroup at presentation.Arch Intern Med. 1988; 48: 2561-2568
- Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule.J Clin Oncol. 1992; 10: 316-322
- Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies.Bone Marrow Transplant. 2000; 26: 211-214
- The multinational association for supportive care in cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients.J Clin Oncol. 2000; 18: 3038-3051
- Neutropenic infections in 100 patients with non-Hodgkin's lymphoma or Hodgkin's disease treated with high-dose BEAM chemotherapy and peripheral blood progenitor cell transplant: out-patient treatment is a viable option.Bone Marrow Transplant. 1999; 23: 599-605
- A prospective study of daily measurement of C-reactive protein in serum of adults with neutropenia.Clin Infect Dis. 1995; 21: 114-121
- C-reactive protein: a valuable aid for the management of febrile children with cancer and neutropenic.Clin Infect Dis. 1994; 18: 589-595
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