Evaluation of febrile neutropenic episodes in adult patients with solid tumors

Yapici,Oktay; Gunseren,Filiz; Yapici,Hafize; Merdin,Alparslan; Yaylali,Ülkü  Üser; Merdin,Fatma  Avci

doi:10.3892/mco.2015.722

Evaluation of febrile neutropenic episodes in adult patients with solid tumors

Authors:
- Oktay Yapici
- Filiz Gunseren
- Hafize Yapici
- Alparslan Merdin
- Ülkü Üser Yaylali
- Fatma Avci Merdin
View Affiliations

Affiliations: Department of Infectiology and Microbiology, Akdeniz University Hospital, Antalya 07059, Turkey, Department of Internal Medicine, Akdeniz University Hospital, Antalya 07059, Turkey
Published online on: December 28, 2015 https://doi.org/10.3892/mco.2015.722
Pages: 379-382
Copyright: © Yapici et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The clinical use of cytotoxic chemotherapeutic agents has increased survival in cancer patients. However, treatment‑associated bone marrow suppression and neutropenia often render patients prone to life‑threatening infections. The aim of this study was to evaluate episodes of febrile neutropenia (FN) in patients with solid tumors, and identify the microorganisms and the factors affecting mortality. A total of 100 primary febrile attacks in cancer patients who were followed up at the Department of Oncology of the Akdeniz University Medical Faculty Hospital between January, 2011 and May, 2012, were retrospectively investigated. FN attacks were classified in three groups as follows: fever of unknown origin, clinically documented infections and microbiologically documented infections. We found that prolonged neutropenia, Multinational Association for Supportive Care in Cancer (MASCC) score <21 and the presence of metastasis increased mortality. We also compared the three groups of infection categories according to mortality rate, but did not observe any significant differences among these groups. Patients with malignancies should be assessed individually during the FN episodes. It is crucial to keep possible infectious pathogens in mind and evaluate the MASCC score, neutropenia duration and metastatic status of the patients, and start empirical antibiotic therapy immediately.

View Figures

View References

1	Klastersky J: Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis. 39(Suppl 1): S32–S37. 2004. View Article : Google Scholar : PubMed/NCBI
2	González-Barca E, Fernández-Sevilla A, Carratalá J, Salar A, Peris J, Grañena A and Gudiol F: Prognostic factors influencing mortality in cancer patients with neutropenia and bacteremia. Eur J Clin Microbiol Infect Dis. 18:539–544. 1999. View Article : Google Scholar : PubMed/NCBI
3	Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K and Talcott J: 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. 18:3038–3051. 2000.PubMed/NCBI
4	Paesmans M: Risk factors assesment in febrile neutropenia. Int J Antimicrob Agents. 16:107–111. 2000. View Article : Google Scholar : PubMed/NCBI
5	Kern WV: Risk assesment and risk-based therapeutic strategies in febrile neutropenia. Curr Opin Infect Dis. 14:415–422. 2001. View Article : Google Scholar : PubMed/NCBI
6	Ahn S and Lee YS: Predictive factors for poor prognosis febrile neutropenia. Curr Opin Oncol. 24:376–380. 2012. View Article : Google Scholar : PubMed/NCBI
7	Hui EP, Leung LK, Poon TC, Mo F, Chan VT, Ma AT, Poon A, Hui EK, Mak SS, Lai M, et al: Prediction of outcome in cancer patients with febrile neutropenia: A prospective validation of the multinational association for supportive care in cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network. Support Care Cancer. 19:1625–1635. 2011. View Article : Google Scholar : PubMed/NCBI
8	Glasmacher A, von Lilienfeld-Toal M, Schulte S, et al: An evidence based evaluation of important aspects of empirical antibiotic therapy in febrile neutropenic patients. Clin Microbiol Infect. 11(5): 17–23. 2005. View Article : Google Scholar : PubMed/NCBI
9	Kern WV: Risk assessment and treatment of low-risk patients with febrile neutropenia. Clin Infect Dis. 42:533–540. 2006. View Article : Google Scholar : PubMed/NCBI
10	Klastersky J, Paesmans M, Georgala A, et al: Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol. 24:4129–4134. 2006. View Article : Google Scholar : PubMed/NCBI
11	Bow EJ, Rotstein C, Noskin GA, Laverdiere M, Schwarer AP, Segal BH, Seymour JF, Szer J and Sanche S: A randomized, open label, multicenter comparative study of the efficacy and safety of piperacillin-tazobactam and cefepime for the empirical treatment of febrile neutropenic episodes in patients with hematologic malignancies. Clin Infect Dis. 43:447–459. 2006. View Article : Google Scholar : PubMed/NCBI
12	Hughes WT, Armostrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL and Young LS: 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 34:730–751. 2002. View Article : Google Scholar : PubMed/NCBI
13	Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA and Wingard JR: Infectious Diseases Society of America: Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 52:e56–e93. 2011. View Article : Google Scholar : PubMed/NCBI
14	Paesmans M: Risk factors assessment in febrile neutropenia. Int J Antimicrob Agents. 16:107–111. 2000. View Article : Google Scholar : PubMed/NCBI
15	Kamana M, Escalante C, Mullen CA, Frisbee-Hume S and Rolston KV: Bacterial infections in low-risk, febrile neutropenic patients. Cancer. 104:422–426. 2005. View Article : Google Scholar : PubMed/NCBI
16	Günalp M, Koyunoğlu M, Gürler S, Koca A, Yeşilkaya I, Öner E, Akkaş M, Metin Aksu N, Demirkan A, Polat O and Elhan AH: Independent factors for prediction of poor outcomes in patients with febrile neutropenia. Med Sci Monit. 20:1826–1832. 2014. View Article : Google Scholar : PubMed/NCBI
17	Zinner SH: Changing epidemiology of infections in patients with neutropenia and cancer: Emphasis on gram-positive and resistant bacteria. Clin Infect Dis. 29:490–494. 1999. View Article : Google Scholar : PubMed/NCBI
18	Wisplinghoff H, Seifert H, Wenzel RP and Edmond MB: Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis. 36:1103–1110. 2003. View Article : Google Scholar : PubMed/NCBI
19	Morris PG, Hassan T, McNamara M, Hassan A, Wiig R, Grogan L, Breathnach OS, Smyth E and Humphreys H: Emergence of MRSA in positive blood cultures from patients with febrile neutropenia - a cause for concern. Support Care Cancer. 16:1085–1088. 2008. View Article : Google Scholar : PubMed/NCBI