Bacteraemia in febrile neutropenic cancer patients

Int J Antimicrob Agents. 2007 Nov;30 Suppl 1:S51-9. doi: 10.1016/j.ijantimicag.2007.06.012. Epub 2007 Aug 8.

Abstract

A total of 2142 patients with febrile neutropenia resulting from cancer chemotherapy were registered in two observational studies and followed prospectively in different institutions. There were 499 (23%) patients with bacteraemia who are reviewed here. The relative frequencies of Gram-positive, Gram-negative and polymicrobial bacteraemias were 57%, 34% and 10% with respective mortality rates of 5%, 18% and 13%. Mortality rates were significantly higher in bacteraemic patients than in non-bacteraemic patients; a trend for higher mortality was observed (without reaching statistical significance) in those patients in whom bacteraemia was associated with a clinical site of infection compared to bacteraemic patients without any clinical documentation. Prophylactic antibiotics but not granulopoiesis stimulating factors were associated with a lower incidence of Gram-negative bacteraemia; however, neither prophylactic approach influenced the subsequent rate of complications in the patients who developed bacteraemia. The present study also confirms that the MASCC scoring system can identify a group of bacteraemic patients with a relatively low risk of complications and death (MASCC >/=21). On the other hand, in patients with very low levels of the MASCC score (<15), and then with predicted very unfavourable risk, the rate of complications and death was dramatically high, irrespective of the microbiological nature of the bacteraemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibiotic Prophylaxis
  • Antineoplastic Agents / therapeutic use
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Bacteremia / mortality
  • Female
  • Fever / etiology*
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Negative Bacterial Infections / mortality
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / microbiology
  • Gram-Positive Bacterial Infections / mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Neoplasms / drug therapy
  • Neutropenia / complications*
  • Prospective Studies

Substances

  • Antineoplastic Agents