[Management of 315neutropenic febrile episodes in a cancer center]

Med Mal Infect. 2009 Jun;39(6):388-93. doi: 10.1016/j.medmal.2008.10.014. Epub 2008 Dec 4.
[Article in French]

Abstract

Management of febrile neutropenic patients is described in guidelines. Each cancer center can adapt these according to its local bacterial ecology. We present a retrospective study made in a cancer center from 2001 to 2003.

Method: Three hundred and fifteen febrile neutropenic episodes after chemotherapy (66% for solid tumor) were analysed.

Results: For 279 episodes, no antibiotic therapy was given before admission. Clinical or radiological manifestations occurred in 46%; microbiologically documented infections by hemocultures in 28% (Gram positive: 42%; Gram negative: 51%) and by puncture in 14% (Gram negative: 58%). The length of pyrexia was inferior to 7 days in 88% and neutropenia inferior 7 days in 80.8%. 79.7% of episodes were treated with one of the three antibiotic therapy recommended by the center (ceftriaxone+tobramycin; ceftriaxone+ciprofloxacin; ceftriaxone+ofloxacin); 13.3% were treated with an other therapy; 7% received no antibiotic therapy. 68.5% of patients treated with one of the three antibiotic therapies, became afebrile without changing the antibiotic protocol.

Conclusion: In our study, there were a majority of Gram negative bacteria except for Pseudomonas aeruginosa. The three antibiotic therapy recommended by the center (third generation cephalosporin+aminoglycosides or fluoroquinolones) were effective and glycopeptide was not necessary in first intention treatment.

Publication types

  • English Abstract

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antineoplastic Agents / adverse effects
  • Drug Therapy, Combination
  • Fever / drug therapy
  • Fever / epidemiology*
  • Fever / etiology
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / epidemiology
  • Humans
  • Neoplasms / complications*
  • Neoplasms / drug therapy
  • Neutropenia / drug therapy
  • Neutropenia / epidemiology*
  • Neutropenia / etiology
  • Retrospective Studies

Substances

  • Anti-Bacterial Agents
  • Antineoplastic Agents