Osmani Asif Husain, Jabbar Adnan Abdul, Gangwani Manesh Kumar, Hassan Bilal
Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan. Email:
Asian Pac J Cancer Prev. 2017 Oct 26;18(10):2741-2745. doi: 10.22034/APJCP.2017.18.10.2741.
Fever during chemotherapy-induced neutropenia continues to be a major cause of morbidity and mortality in cancer patients. Mortality depends on the duration and degree of neutropenia, bacteremia, sepsis, performance status, comorbidities and other parameters. The highest mortality rates in cancer patients hospitalized with febrile neutropenia (FN) are observed in those with documented infection. The objectives of the study were to present available tools for risk assessment, to review pathogens causing infections in adult FN patients and to assess outcomes. Methods: This cross sectional study was conducted on adult culture positive FN patients admitted to the Hematology/Oncology service at the Aga Khan University Hospital, Karachi, Pakistan from 1st January 2009 to 31st December 2012. Highrisk criteria were defined as profound neutropenia, short latency from a previous chemotherapy cycle, sepsis or clinically documented infection at presentation, severe co-morbidity and a performance status greater than or equal to 3. All types of organisms in blood culture and the outcomes of the patients were recorded on Proforma. Results: A total of 156 patients with culture-positive febrile neutropenia were identified during the study period. The mean age was 47 years with a slight male predominance of 54%. One hundred and sixteen patients fulfilled the criteria for the high risk group. Fifty two percent had a single high risk factor and 40 % had two. All patients harbored either single or multiple bacterial organisms including gram positive, gram negative or both types. Some 34% of patients had gram positive bacteremia, 57 % had gram negative and 9 % were infected with both. Among 73 gram positive cultures 44 % were Staphylococcus species and among 123 gram negative cultures 43 % were E. coli. One hundred and fifteen patients recovered uneventfully and could be discharged. Thirty two patients in the high risk and 9 in the low risk groups deceased with an overall mortality of 26 %. The mean hospital stays of patients with solid tumors and hematological malignancies were 7.58 and 15.0 days, respectively. Mortality was higher in the latter group, and also in high risk patients with both gram positive and negative bacteremia. Conclusion: We emphasize the importance of risk stratification and continuous surveillance of the spectrum of locally prevalent pathogens and their susceptibility patterns for formulation of therapeutic regimens for febrile neutropenic patients.
化疗所致中性粒细胞减少期间的发热仍然是癌症患者发病和死亡的主要原因。死亡率取决于中性粒细胞减少的持续时间和程度、菌血症、败血症、身体状况、合并症及其他参数。在因发热性中性粒细胞减少（FN）住院的癌症患者中，死亡率最高的是那些有明确感染的患者。本研究的目的是介绍可用的风险评估工具，回顾导致成年FN患者感染的病原体，并评估预后。方法：本横断面研究针对2009年1月1日至2012年12月31日期间入住巴基斯坦卡拉奇阿迦汗大学医院血液科/肿瘤科的成年血培养阳性FN患者。高危标准定义为严重中性粒细胞减少、距上一个化疗周期的潜伏期短、就诊时出现败血症或临床记录的感染、严重合并症以及身体状况评分大于或等于3分。血培养中的所有类型微生物及患者的预后情况均记录在表格中。结果：研究期间共确定了156例血培养阳性的发热性中性粒细胞减少患者。平均年龄为47岁，男性略占优势，占54%。116例患者符合高危组标准。52%的患者有单一高危因素，40%的患者有两个高危因素。所有患者均携带单一或多种细菌，包括革兰氏阳性菌、革兰氏阴性菌或两者皆有。约34%的患者有革兰氏阳性菌血症，57%有革兰氏阴性菌血症，9%同时感染了两种细菌。在73份革兰氏阳性菌培养物中，44%为葡萄球菌属；在123份革兰氏阴性菌培养物中，43%为大肠杆菌。115例患者顺利康复并可出院。高危组32例患者和低危组9例患者死亡，总死亡率为26%。实体瘤和血液系统恶性肿瘤患者的平均住院天数分别为7.58天和15.0天。后者的死亡率更高，革兰氏阳性菌和阴性菌血症的高危患者死亡率也更高。结论：我们强调风险分层以及持续监测当地流行病原体谱及其药敏模式对于制定发热性中性粒细胞减少患者治疗方案的重要性。
