Science and pragmatism in the treatment and prevention of neutropenic infection.

Service de Médecine Interne et Laboratoire d'Investigation Clinique H. Tagnon, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium.
Journal of Antimicrobial Chemotherapy (Impact Factor: 5.44). 07/1998; 41 Suppl D:13-24. DOI: 10.1093/jac/41.suppl_4.13
Source: PubMed

ABSTRACT The following aspects of the management of patients with granulocytopenia and fever are reviewed in this article: adaptation of initial antibiotic regimens to the recent changes in the most common causative pathogens (namely a change from Gram-negative bacteria to Gram-positive bacteria and fungi); subsequent modifications of the empirically administered treatments; improvement of the host's defence by reducing the duration of neutropenia; and indications for out patient therapy of febrile episodes.

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    ABSTRACT: The aim of this study was to determine the epidemiology, clinical manifestations, and outcome of health-care associated bacteremia in geriatric cancer patients with febrile neutropenia. We retrospectively evaluated cancer patients with febrile neutropenia aged ≥60years with culture proven health-care associated bacteremia between January 2005 and December 2011. The date of the first positive blood culture was regarded as the date of bacteremia onset. Primary outcome was the infection related mortality, defined as the death within 14days of bacteremia onset. The two most common pathogens responsible for bacteremia were Staphylococcus epidermidis (36.1%) and Escherichia coli (31.5%), with high rates of methicillin resistance and extended-spectrum β-lactamase (ESBL) production, respectively. There were no statistically significant differences in infection related mortality rate according to the type of malignancy (p=0.776). By the univariate analysis, factors associated with 14day mortality among febrile neutropenic episodes were prolonged neutropenia (p=0.024), persistent fever (p=0.001), hospitalization in ICU (p<0.001) and the initial clinical presentations including respiratory failure (p<0.001), hepatic failure (p=0.013), hematological failure (p<0.001), neurological failure (p<0.001), severe sepsis (p<0.001), and septic shock (p=0.036). Multivariate analysis showed that persistent fever was an independent factor associated with infection related mortality (odds ratio, 18.0; 95% confidence interval, 5.2-62.6; p<0.001). The only independent risk factor for mortality was persistent fever. Although the most frequently isolated pathogens were S. epidermidis and E. coli, high rates of methicillin resistance and ESBL production were found respectively.
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