Evaluation of Febrile Neutropenia in Patients Undergoing Hematopoietic Stem Cell Transplantation
The aim of this study was to determine the incidence and causes of fever as a major problem contributing to transplantation related mortality among patients undergoing hematopoietic stem cell transplantation (HSCT) and evaluation of antibiotic use, according to reliable guidelines.We retrospectively reviewed hospital records of 195 adult patients who underwent HSCT between 2009-2011 at hematology-oncology and bone marrow transplantation research center. Baseline information and also data related to fever and neutropenia, patient's outcomes, duration of hospitalization and antibiotic use pattern were documented.A total of 195 patients were analyzed and a total of 268 febrile episodes in 180 patients were recorded (mean 1.5 episodes per patient). About 222 episodes (82%) were associated with neutropenia which one-fourth of them were without any documented infection sources. Microbiologic documents showed that the relative frequencies of gram positive and gram negative bacteria were 62.5% and 37.5%, respectively. The hospital stay duration was directly related to the numbers of fever episodes (P<0.0001).The rate of febrile episodes in autologous stem cell transplantation was significantly higher compared to allogeneic type (P<0.05).It is necessary to determine not only the local profile of microbiologic pattern, but also antibiotic sensitivities in febrile neutropenic patients following hematopoietic stem cell transplantation, and reassess response to antibiotic treatment to establish any necessity for modifications to treatment guidelines in order to prevent any fatal complications from infection.
Engels EA, Ellis CA, Supran SE, et al. Early infection in bone marrow transplantation: quantitative study of clinical factors that affect risk. Clin Infect Dis 1999;28(2):256-66.
Bjorklund A, Aschan J, Labopin M, et al. Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantation. Bone Marrow Transplant 2007;40(11):1055-62.
Picazo JJ. Management of the febrile neutropenic patient. Int J Antimicrob Agents 2005;26(Suppl 2):S120-2.
Link H, Böhme A, Cornely O, Höffken K, Kellner O, Kern W, et al. Antimicrobial therapy of unexplained fever in neutropenic patients-guidelines of the Infectous Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study GroupInterventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG) german Cancer Society. Ann Hematol 2003;82 Suppl 2(12):105-17.
Walter EA, Bowden RA. Infection in the bone marrow transplant recipient. Infect Dis Clin North Am 1995;9(4):823-47.
Glasmacher A, von Lilienfeld‐Toal M, Schulte S, et al. An evidence‐based evaluation of important aspects of empirical antibiotic therapy in febrile neutropenic patients. Clin Microbiol Infect 2005;11(Suppl 5):17-23.
Irfan S, Idrees F, Mehraj V, et al. Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: a descriptive study. BMC Infect Dis 2008;8(1):80.
Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34(6):730-51.
Prevention and treatment of cancer-related infection NCCN V 2 2009. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network (Accessed in Jan 27, 2014, at http://www.nccn.org/professionals/physician_gls/PDF/infe ctions.pdf).
Salutari P, Sica S, Laurenti L, et al. Incidence of sepsis after peripheral blood progenitor cells transplantation: Analysis of 86 consecutive hemato oncological patients. Leuk Lymphoma 1998;30(1-2):193-7.
Ninin E, Milpied N, Moreau P, et al. Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis 2001;33(1):41-7.
Jagarlamudi R, Kumar L, Kochupillai V, et al. Infections in acute leukemia: an analysis of 240 febrile episodes. Medl Oncol 2000;17(2):111-6.
Lazarus HM, Creger RJ, Gerson SL. Infectious emergencies in oncology patients. Semin Oncol 1989;16(6):543-60..
Kumar L, Kochupillai V, Bhujwala RA. Infections in acute myeloid leukemia. Study of 184 febrile episodespi. J Assoc Physicians India 1992;40(1):18-20.
Klastersky J, Ameye L, Maertens J, et al. Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents 2007;30(Suppl 1):S51-9.
Collin BA, Leather HL, et al. Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 2001;33(7):947-53.
Orasch C, Weisser M, Mertz D, et al. Comparison of infectious complications during induction/consolidation chemotherapy versus allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplantation 2010;45(3):521-6.
Antoniadou A, Giamarellou H. Fever of unknown origin in febrile leukopenia. Infect Dis Clin North Am 2007;21(4):1055-90.
Calandra T. Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group. J Infect Dis 1991;163(5):951-8.
Paul M, Borok S, Fraser A, et al. Empirical antibiotics against Gram-positive infections for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2005;55(4):436-44.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.