Clinical and Microbiological Characteristics of Febrile Neutropenia During Induction Chemotherapy in Adults With Acute Leukemia.

BACKGROUND: Few studies regarding infectious causes of febrile neutropenia (FN) in Mexico are available. AIMS: We aimed to describe clinical and microbiological characteristics of FN episodes during induction chemotherapy in adults with acute leukemia. METHODS AND RESULTS: This retrospective cohort from a Mexican tertiary care center included adults with newly diagnosed acute leukemia between January 2014, and December 2018. Clinical and microbiological characteristics were summarized using descriptive statistics. Univariate analyses for associations between clinical characteristics and FN and/or death were made; logistic regression analysis was performed to assess relationships with FN. Kaplan-Meier survival estimates were modeled for antimicrobial prophylaxis and FN. Ninety-five patients were included. Median age was 28 (IQR 20-43), 49 (52%) were males, and 74 (78%) developed FN (74/95). Among these, 98% had an identified source of infection (73/74) and 65% had >1. Common infections were urinary tract infection (24%), bacterial sinusitis (20%), and bacterial pneumonia (19%). Gram-negatives were the most frequently isolated microorganisms (69%), followed by Gram-positives (21%), and fungi (9%). Antimicrobial prophylaxis was inversely associated with FN (aOR = 0.07, CI 0.008-0.060, p = 0.02). Invasive fungal diseases were associated with 30-day mortality (aOR = 9.46, 95% CI 1.66-54.05). CONCLUSION: Infections caused 98% of the FN episodes. Gram-negative bacteria are the most common pathogens.

[Febrile neutropenia in cancer patients: management in the emergency room]. / Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias.

Febrile neutropenia is a life-threatening condition that requires immediate attention, especially in patients with chemotherapy-related neutropenia. Patients with febrile neutropenia have a much greater risk of developing bacterial disease, and fever may be the only indicator of severe bacterial infection. Adequate management of febrile neutropenia emphasizes early recognition of patients, risk stratification, and antibiotic therapy administration during the first 60 minutes of admission to an emergency room. Not all children with febrile neutropenia carry the same risk of morbidity and mortality, so in recent years, efforts have been made to distinguish between high-risk patients where more aggressive hospital management is required. In children classified as low-risk, outpatient management may be considered initially or after 72 hours, whilst high-risk patients should be hospitalized and managed with parenteral antibiotics.

Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias / Febrile neutropenia in cancer patients: management in the emergency room

Resumen La neutropenia febril es una condición que puede amenazar la vida y que requiere de atención inmediata, particularmente en pacientes en que la misma está asociada a tratamientos con quimioterapia. Estos pacientes tienen un riesgo mucho mayor de desarrollar enfermedades bacterianas, y en ellos, la fiebre puede ser el único indicador de enfermedad bacteriana grave. El manejo adecuado de la neutropenia febril da énfasis en la identificación pronta de los pacientes, estratificación del riesgo y antibioterapia iniciada durante los primeros 60 min del ingreso al servicio de emergencias. No todos los niños con neutropenia febril conllevan el mismo riesgo de morbi-mortalidad, por lo que en los últimos años se han hecho esfuerzos para distinguir entre pacientes de alto riesgo en quienes se recomienda el manejo hospitalario más agresivo. En pacientes que se clasifican como de bajo riesgo se puede considerar el manejo ambulatorio inicial o después de 72 h, mientras que en aquellos de alto riesgo se recomienda hospitalizar y manejar con antimicrobianos parenterales.

Febrile neutropenia is a life-threatening condition that requires immediate attention, especially in patients with chemotherapy-related neutropenia. Patients with febrile neutropenia have a much greater risk of developing bacterial disease, and fever may be the only indicator of severe bacterial infection. Adequate management of febrile neutropenia emphasizes early recognition of patients, risk stratification, and antibiotic therapy administration during the first 60 minutes of admission to an emergency room. Not all children with febrile neutropenia carry the same risk of morbidity and mortality, so in recent years, efforts have been made to distinguish between high-risk patients where more aggressive hospital management is required. In children classified as low-risk, outpatient management may be considered initially or after 72 hours, whilst high-risk patients should be hospitalized and managed with parenteral antibiotics.

Modelo predictivo de bacteriemia en pacientes neutropénicos febriles / Predictive model of bacteremia in febrile neutropenic patients

La neutropenia febril (NF) es la complicación más frecuente del tratamiento quimioterápico en los pacientes con cáncer. Es considerada una emergencia médica. La atención de los enfermos debe ser pronta y conveniente para contribuir a la disminución de la mortalidad. Como objetivos se propuso: 1) identificar distintos grupos de pacientes según factores de riesgo y la enfermedad neoplásica; 2) conocer la microbiología local de las infecciones; 3) relacionar los diferentes citostáticos con la evolución de los episodios; 4) elaborar un modelo predictivo de riesgo de bacteriemia; 5) sistematizar el tratamiento antimicrobiano empírico; 6) desarrollar una pauta de manejo inicial regionalizada. El trabajo se realizó en el Instituto Oncológico Universitario del Hospital Nacional de Clínicas de Córdoba. Se incluyeron los pacientes con diagnóstico de NF secundaria a quimioterapia y enfermedades neoplásicas y que fueran internados. Criterios de inclusión: recuento de neutrófilos en sangre circulante <0,5 x 109/L ó <1,0 x 109/L con predicción de descenso a <0,5 x 109/L en las siguientes 24 horas y con temperatura axilar > a 38 °C. Se los dividió en un grupo retrospectivo (140 pacientes, desde 01/01/00 al 31/12/08) y otro prospectivo (36 pacientes, desde 01/01/09 al 31/12/10). Los datos disponibles fueron organizados en una planilla de cálculo Excel y luego procesados con el software SPSS 17. En una primera etapa, se realizó un análisis descriptivo univariado, completado con un análisis multivariado utilizando las técnicas de correspondencias múltiples y conglomerados. Para detectar asociaciones entre las variables se usaron pruebas estadísticas de Chi Cuadrado.

SUMMARY: Febrile neutropenia (FN) is the most common complication of chemotherapy in cancer patients. It is considered a medical emergency. The patient must be attended soon and conveniently to decrease the risk of death. The objectives proposed were: 1) identify different groups of patients according to the risk factors and the neoplastic disease; (2) know the local microbiology of infections; (3) link the cytostatics to the episodes evolution; (4) develop a predictive model of risk related to bacteremia; (5) systematize the empirical antimicrobial treatment; (6) develop a regionalized initial guideline of management. The study was conducted in the University Cancer Institute of the National Hospital of Clinics in Córdoba (Argentina). It included patients with diagnosis of NF secondary to chemotherapy and neoplastic diseases. Inclusioncriteria: neutrophil count in peripheral blood <0,5 x 109/L o <1,0 x 109/L with prediction of descent to <0,5 x 109/L in the next 24 hours and axillary temperature > 38 °C. They were divided into a retrospective group (140 patients, from 01/01/00 to 31/12/08) and a prospective one (36 patients, from 01/01/09 to 31/12/10). Available data were organized in a form of Excel spreadsheets and then processed with the software SPSS 17. .

Procalcitocina en pacientes con neutropenia y fiebre secundarias a quimioterapia / Procalcitocina in patients with neutropenia and fever secondary to chemotherapy

Los pacientes con malignidades hematológicas frecuentemente se complican por infecciones. La procalcitonina (PCT) puede diferenciar la sepsis de la inflamación. Establecer la utilidad de PCT para determinar complicaciones infecciosas en adultos con malignidades hematológicas y neutropenia febril (NF) provenientes de la Ciudad Hospitalaria “Dr. Enrique Tejera” (CHET) y Centro Policlínico Valencia (CPV), Valencia, Venezuela. Estudio prospectivo que incluyó 30 pacientes neutropénicos febriles (H:M, 20:10), edad 49,4±21 años. En 5ml de sangre venosa, extraidos en las primeras 48 horas siguientes a la fiebre, se midió mediante ensayo semicuantitativo PCT-Q®. PCT<0.5ng/ml considerada negativa, >0.5 <2ng/ml infección sistémica, >2 <10ng/ml posible sepsis severay >10ng/ml: posible shock séptico. Se utilizó estadística descriptiva y probabilidad de asociación mediante test de Fisher, con p<0,05 considerada estadísticamente significativa. La asociación entre PCT y hallazgos clínicos de infección no fue estadísticamente significativa (p = 0,1); la asociación entre PCT y hemocultivos positivos fue estadísticamente significativa (p = 0,006) y también entre PCT y mortalidad (p = 0,034). La PCT elevada se asocia a bacteriemia y mortalidad en adultos neutropéniucos febriles, empeorando su pronóstico

Frequently patients with haematologic malignancies (HM) are complicated with infections. Procalcitonin (PCT) allows to differentiate sepsis from inflammation. To assess the usefulness of PCT in infectious complications in adult patients with HM and febrile neutropenia (FN). This prospective study, included 30 FN patients (M:F,20:10), age 49,4±21 years. A blood sample in the first 48 hours after the start of fever PCT was processed by semi-quantitative assay (PCT-Q®). Values of PCT<0.5ng / ml were considered negative, >0.5<2ng/ml suggested systemic infection, >2<10ng/ml, possible severe sepsis and >10ng/ml possible septic shock. Descriptive statistics and probability of association by fisher test were performed and p < 0,05 considered statistically significant. There was no stastical correlation between PCT and clinical findings of infection (p= 0,1) but between PCT and positive blood cultures it was statistically significant (p = 0,006) and also between PCT and mortality (p = 0,034). Elevated PCT is associated with bacteremia and mortality among adult FN patients with HM, worsening their prognosis