Outcome of febrile neutropenia in patients with leukemia and lymphoma in Siriraj Hospital.

ABSTRACT

One-hundred and forty-nine patients treated between January and June,1998 were reviewed. One-hundred and forty-seven patients received chemotherapy. A total of 352 cycles of chemotherapy were given with 64 episodes of documented febrile neutropenia. The median age was 35 years in acute leukemia (range 11-73) and 53 years in lymphoma (range 12-85). Twenty-two episodes of febrile neutropenia occurred in females and 42 episodes occurred in males. Fifty-six episodes occurred in patients with acute leukemia (88%), and the remainder in patients with lymphoma (12%). The incidence of febrile neutropenia in our patients with acute leukemia was 59% and less than 1% in patients with lymphoma. Eighteen episodes had positive cultures (28%); of these 14 episodes had bacteremia. The most frequent organisms identified were Pseudomonas aeruginosa (2-bacteremia) and E. coli (2-bacteremia and 1-bacteriuria). Other Gram-negative organisms were K. pneumoniae (1-bacteremia and 1-pneumonia), Enterobacter cloacae (1-bacteremia and bacteriuria), nonfermentative GNB (1-bacteremia), Proteus mirabilis (1-bacteremia), Aeromonas hydrophilla (1-bacteremia) and Acinetobacter (1-bacteriuria). Other organisms were Gram-positive bacteria, Staphylococcus aureus and group A Streptococcal bacteriuria. One BAL fluid culture was positive for Candida albicans. The overall mortality rate was 26.4% (18 deaths in 147 patients16-acute leukemia and 2-lymphoma patients). Seventy-four percent of febrile neutropenic episodes resolved without serious morbidity after empirical antibiotic treatment. The most frequent antibiotic regimen used in this series was a combination of ceftazidime and amikacin.