Department of Infectious Diseases and Clinical Microbiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Department of Infectious Diseasesand Clinical Microbiology, Bakırkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
J Infect Dev Ctries. 2020 Aug 31;14(8):886-892. doi: 10.3855/jidc.12520.
We aimed to evaluate the epidemiology of infections and factors associated with mortality in patients with febrile neutropenia (FEN).
The adult patients, who developed FEN after chemotherapy due to a hematologic malignancy or a solid tumor in a training and research hospital were evaluated, retrospectively. The demographic data of the patients, underlying malignancy, administered antimicrobial therapy, microbiological findings, and other risk factors associated with mortality were evaluated.
A total of 135 FEN episodes of 115 patients, who comprised of 72 (63%) patients with 89 FEN episodes due to hematologic malignancies (hemato-group) and 43 (37%) patients with 46 FEN episodes due to solid organ cancers (onco-group), were evaluated in the study. The median age was 47 years (range: 17-75 years) and 66 (57%) patients were male. A total of 12 patients (8.8%) died during 135 episodes of FEN including nine cases from hemato-group and three cases from onco-group. Those factors including a presence of pneumonia, advanced age, persistent fever despite an antimicrobial treatment, and need for mechanical ventilation in intensive care unit (ICU) with were determined as risk factors associated with mortality.
Morbidity and mortality are more common in patients with hematological malignancies compared to patients with solid organ cancers due to prolonged neutropenia. In case of persistent fever, an invasive fungal infection (IFI) should be kept in mind in patients with hematologic malignancies and then antifungal treatment should be initiated. Although a persistent fever is also common in patients with solid tumors, the necessity of antifungal therapy is rare due to the short duration of neutropenia.
我们旨在评估发热性中性粒细胞减少症（FEN）患者感染的流行病学和与死亡率相关的因素。
在一家培训和研究医院，回顾性评估了因血液恶性肿瘤或实体瘤接受化疗后发生 FEN 的成年患者。评估了患者的人口统计学数据、基础恶性肿瘤、给予的抗菌治疗、微生物学发现以及与死亡率相关的其他危险因素。
研究共评估了 115 例患者的 135 次 FEN 发作，其中 72 例（63%）患者因血液恶性肿瘤（血液组）发生 89 次 FEN 发作，43 例（37%）患者因实体器官癌症（肿瘤组）发生 46 次 FEN 发作。中位年龄为 47 岁（范围：17-75 岁），66 例（57%）为男性。在 135 次 FEN 发作中，共有 12 例（8.8%）患者死亡，其中 9 例来自血液组，3 例来自肿瘤组。存在肺炎、年龄较大、尽管进行了抗菌治疗仍持续发热以及需要在重症监护病房（ICU）进行机械通气等因素被确定为与死亡率相关的危险因素。
与患有实体器官癌症的患者相比，由于中性粒细胞减少持续时间较长，血液恶性肿瘤患者的发病率和死亡率更高。如果持续发热，应考虑血液恶性肿瘤患者发生侵袭性真菌感染（IFI）的可能性，然后应开始抗真菌治疗。尽管发热也常见于患有实体瘤的患者，但由于中性粒细胞减少的持续时间较短，抗真菌治疗的必要性很少。
