Bachlitzanaki Maria, Aletras George, Bachlitzanaki Eirini, Messaritakis Ippokratis, Koukias Stergos, Koulouridi Asimina, Bachlitzanakis Emmanouil, Kaloeidi Eleni, Vakonaki Elena, Kontopodis Emmanouil, Androulakis Nikolaos, Chamilos Georgios, Mavroudis Dimitrios, Ioannou Petros, Kofteridis Diamantis
Department of Internal Medicine, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece.
School of Medicine, University of Crete, 71003 Heraklion, Greece.
Microorganisms. 2023 Oct 12;11(10):2547. doi: 10.3390/microorganisms11102547.
Febrile neutropenia (FN) is a common but serious complication encountered in patients with cancer and is associated with significant morbidity and mortality. In this prospective study, 63 patients with solid tumors under chemotherapy or immunotherapy were admitted to the hospital due to febrile neutropenia, confirmed through clinical or microbiological documentation. The aim of this study was to provide a comprehensive overview of the epidemiological and microbiological characteristics of hospitalized neutropenic patients with solid tumors undergoing treatment. Additionally, we aimed to assess the duration of neutropenia and identify factors influencing patient outcomes. The median age of patients was 71 ± 10.2 years, most of which were males (66.7%), and the primitive tumor location was the lung (38.1%), with most patients (82.5%) being at disease stage IV. The median duration of neutropenia was three days (range 1-10), and, notably, mucositis was significantly associated with neutropenia lasting ≥3 days ( = 0.012). Patients with lung cancer (38.1%) and patients with stage IV disease (82.5%) presented a higher risk of FN, although these differences did not reach statistical significance. The site of infection was identifiable in 55.6% of patients, with positive cultures detected in 34.9% and positive blood cultures (BC) drawn in 17.5% of cases. Gram-positive bacteria were the predominant causative agents in BC (63.6%), with being the most prevalent among them (66.7%). The median duration of hospitalization was nine days (range, 3-43 days), and most patients showed improvement or cure of infection (16.9% and 74.6%, respectively). Among recorded risk factors, the Eastern Cooperative Oncology Group (ECOG) performance status (PS) appears to be statistically significant. Patients with an impaired PS score (2-4) experienced worse outcomes and higher likelihood of mortality ( = 0.004). Regarding the outcome, a longer duration of neutropenia was also statistically significant ( = 0.050). Of the patients, 12.7% ultimately succumbed to their conditions, with 37.5% attributed to infections. FN is a common yet serious complication in solid tumor patients. Adequate knowledge of the predictors of mortality and the microbiological causes are of utmost importance to allow accurate diagnosis and prompt treatment as they significantly influence patient outcomes.
发热性中性粒细胞减少症(FN)是癌症患者中常见但严重的并发症,与显著的发病率和死亡率相关。在这项前瞻性研究中,63例接受化疗或免疫治疗的实体瘤患者因发热性中性粒细胞减少症入院,经临床或微生物学记录确诊。本研究的目的是全面概述接受治疗的实体瘤住院中性粒细胞减少患者的流行病学和微生物学特征。此外,我们旨在评估中性粒细胞减少的持续时间,并确定影响患者预后的因素。患者的中位年龄为71±10.2岁,大多数为男性(66.7%),原发肿瘤部位为肺部(38.1%),大多数患者(82.5%)处于疾病IV期。中性粒细胞减少的中位持续时间为3天(范围1 - 10天),值得注意的是,口腔炎与中性粒细胞减少持续≥3天显著相关(P = 0.012)。肺癌患者(38.1%)和IV期疾病患者(82.5%)发生FN的风险较高,尽管这些差异未达到统计学意义。55.6%的患者可确定感染部位,34.9%的患者培养结果为阳性,17.5%的病例血培养(BC)结果为阳性。革兰氏阳性菌是血培养中的主要病原体(63.6%),其中金黄色葡萄球菌最为常见(66.7%)。中位住院时间为9天(范围3 - 43天),大多数患者的感染情况有所改善或治愈(分别为16.9%和74.6%)。在记录的风险因素中,东部肿瘤协作组(ECOG)体能状态(PS)似乎具有统计学意义。PS评分受损(2 - 4分)的患者预后较差,死亡可能性更高(P = 0.004)。关于预后,中性粒细胞减少持续时间较长也具有统计学意义(P = 0.050)。患者中,12.7%最终死于病情,37.5%归因于感染。FN是实体瘤患者中常见且严重的并发症。充分了解死亡率预测因素和微生物学病因对于准确诊断和及时治疗至关重要,因为它们会显著影响患者预后。