Epidemiological, clinical and prognostic features of febrile neutropenia in cancer patients

Abstract number: 1134_03_366

Aguilar-Guisado M., Cordero E., Cisneros J., Espigado I., Parody R., Pachón J.

Objective:  

To describe epidemiology, aetiology, clinical and prognostic features of febrile neutropenia (FN) in patients with solid or haematological neoplasms.

Method:  

Prospective observational study of all FN episodes, among patients admitted in Oncology and Haematology Departments during 21 months (November 2002–August 2004) with either haematological or solid neoplasm of any localization.

Results:  

We studied 292 episodes of FN in 227 patients. 50.3% were males. Median age was 51 years (16–84). 79% had a haematological neoplasm, 21% a solid neoplasm, and 21% were blood stem-cell transplantation recipients. Most frequent malignat disease was acute leukaemia (36%) followed by lymphoma (24%). 22% had a chronic disease different from the neoplasm. A diagnosis of infection was established in 59% of episodes (N = 173), and in 48.5% of them an aetiological diagnosis was established. More frequent infections were pneumonia (30%), catheter infection (22%), primary bacteraemia (20%) and urinary tract infections (9%). 73 patients (42%) had bacteraemia. Bacteria (82%) were the most common infectious aetiology, followed by mixed infections by fungi and bacteria (14%) and fungal infections alone (4%). Between bacteria, the most frequent were: Staphylococcus coagulase-negative (30%), Escherichiacoli (20%), Pseudomonasaeruginosa (13%), Staphylococcusaureus (9%), Enterococcusfaecium (3%) and Proteusmirabilis (3%). Between fungi the most frequent were Aspergillus spp (13%) and Pneumocystisjiroveci (3%). 21% of FN presented wtih severe clinical features, among them the most frequent were arterial hypotension (16%) and acute renal failure (8%). FN episodes with a diagnosis of infection had a higher frequence of severe clinical features in comparison with these with unknown aetiology (p = 0.003; RR 2.18; IC 95%: 1.3–5.3). Mortality at 30th day of episode was 17%. Pneumonia (p = 0.04;RR 2.2; IC 95%: 1.1–4.8), aetiological diagnosis of infection (p < 0.01;RR 2.3; IC 95%: 1.2–4.5), and septic shock (p < 0.001; RR 10; IC 95%: 3.5–28.9) were adverse outcome factors identified by multivariate analysis.

Conclusions:  

Infection is the cause of at least 59% of FN episodes in patients with cancer. The aetiology of infection is established in one half of episodes, with a predominance of bacteria. Pneumonia and catheter infection are the most frequent infection foci. Pneumonia, aetiological diagnosis of infection and septic shock are adverse outcome factors in patients with FN and cancer.