Noronha V, Joshi A, Patil V M, Bhosale B, Muddu V K, Banavali S, Kelkar R, Prabhash K
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Cancer. 2014 Oct-Dec;51(4):470-4. doi: 10.4103/0019-509X.175306.
Indian febrile neutropenia (FN) data are limited, especially in adult solid tumor patients.
The aim was to study patterns of presentation, source of infection, management and outcome and to evaluate the factors which may correlate with outcome.
A retrospective analysis of prospective data of FN patients at a tertiary care oncology teaching hospital in India between 2007 and 2012. A standardized form was filled for each patient. Patient management was at the discretion of the treating physician. Multinational Association for Supportive Care in Cancer (MASCC) score was retrospectively calculated. Failure of therapy was defined as death, organ failure, shifting from outpatient to inpatient or requirement of intensive care support. SPSS version 16 was used for analysis.
A total of 388 FN episodes were included: 256 in hematolymphoid and 132 in solid tumor patients. 156 episodes were high-risk by MASCC score. Focus of infection was clinical in 45% and radiologic in 16%. Blood cultures were positive in 18% cases, most commonly Gram-negative organisms (72%). 93% patients were treated with an antibiotic combination of third-generation cephalosporin/beta-lactamase inhibitor, with aminoglycoside or fluoroquinolone. Antibiotic sensitivity to ceftriaxone was low at 38% while sensitivity to cefoperazone/sulbactam and piperacillin/tazobactam ranged between 50% and 55% and for carbapenems 75%. Failure of therapy occurred in 156 episodes, most commonly due to the need for second line antibiotics. Mortality was 5.5%. On univariate analysis, MASCC score, age, type of malignancy, prophylactic growth factors, presence of focus of infection, hemoglobin and nadir platelet count correlated with FN complications.
Gram-negative bacteremia continues to be the predominant cause of FN in our setup.
印度关于发热性中性粒细胞减少症（FN）的数据有限，尤其是在成年实体瘤患者中。
本研究旨在探讨FN的临床表现模式、感染源、治疗及转归情况，并评估可能与转归相关的因素。
对2007年至2012年期间印度一家三级肿瘤教学医院中FN患者的前瞻性数据进行回顾性分析。为每位患者填写标准化表格。患者的治疗由主治医生自行决定。回顾性计算癌症支持治疗多国协会（MASCC）评分。治疗失败定义为死亡、器官衰竭、从门诊转为住院或需要重症监护支持。采用SPSS 16版进行分析。
共纳入388例FN发作病例：血液淋巴系统疾病患者256例，实体瘤患者132例。根据MASCC评分，156例为高危病例。45%的感染灶通过临床诊断，16%通过影像学诊断。18%的血培养结果呈阳性，最常见的是革兰阴性菌（72%）。93%的患者接受了第三代头孢菌素/β-内酰胺酶抑制剂联合氨基糖苷类或氟喹诺酮类抗生素治疗。对头孢曲松的抗生素敏感性较低，为38%，而对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的敏感性在50%至55%之间，对碳青霉烯类的敏感性为75%。156例出现治疗失败，最常见的原因是需要二线抗生素治疗。死亡率为5.5%。单因素分析显示，MASCC评分、年龄、恶性肿瘤类型、预防性生长因子、感染灶的存在、血红蛋白和最低血小板计数与FN并发症相关。
在我们的研究中，革兰阴性菌血症仍然是FN的主要原因。
