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Clinical guidelines for the management of cancer patients with neutropenia and unexplained fever

2005; Elsevier BV; Volume: 26; Linguagem: Inglês

10.1016/j.ijantimicag.2005.08.007

1872-7913

Huang Xj, Shen Zhixiang, Chun Wang, Ary Harryanto Reksodiputro, Dody Ranuhardy, Kazuo Tamura, Tetsuro Matsumoto, Dong‐Gun Lee, S. Visalachy Purushotaman, V. Lim, Altaf Ahmed, Yasser Hussain, Manolito Chua, Adrian Ong, Cheng‐Yi Liu, Po‐Ren Hsueh, Shaeng-Fung Lin, Yung-Ching Liu, P Suwangool, Saengsuree Jootar, Juan J. Picazo,

Mycobacterium research and diagnosis

This study was conducted to compare the clinical and microbiological characteristics of first and breakthrough neutropenic fever in hematologic malignancy patients after chemotherapy.Breakthrough neutropenic fever was any episode of fever, not present initially, that developed either during antibiotic therapy or within 1 week of discontinuation of therapy. A total of 687 neutropenic fever episodes in 241 patients were observed from April 2003 to March 2014.Blood cultures revealed 210 causative microorganisms: 199 (94.8%) were bacteria and 11 (5.2%) were fungi. Gram-negative bacteria predominated in both types of neutropenic episode (first 75% (120/160) vs. breakthrough 56% (18/32)) and the most common pathogen was Escherichia coli. Antibiotic resistance rates were higher in breakthrough episodes than first episodes (piperacillin/tazobactam 6% vs. 31%, p = 0.006; ceftazidime 9% vs. 31%, p = 0.025). Inappropriate empirical antibiotic treatment was also more frequent (0% vs. 19%, p = 0.001), as was the 30-day mortality rate (4.3% (19/442) vs. 7.9% (19/245), p = 0.058), although the latter effect was not statistically significant.It is concluded that the epidemiological profile of breakthrough neutropenic fever is different from that of first episode fever. These data reinforce the view that pooled reporting of neutropenic fever may be misleading, and that clinicians should approach breakthrough fever as a distinct entity.