Dijkshoorn-Fokker Dorine, Marina Madalina, van Bruchem-van de Scheur Ada, Oldenmenger Wendy, Rijnders Bart, Versluis Jurjen, Wlazlo Nick
Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands.
Master Advanced Nursing Practice, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
Open Forum Infect Dis. 2025 Jul 18;12(8):ofaf419. doi: 10.1093/ofid/ofaf419. eCollection 2025 Aug.
In hematological patients with febrile neutropenia, chest X-rays are frequently performed to exclude possible pulmonary infections. However, the diagnostic and therapeutic value of this imaging remains unclear.
We conducted a retrospective observational cohort study over a 2-year period, examining episodes of febrile neutropenia in adult patients treated with myelosuppressive chemotherapy. Febrile episodes were categorized based on the presence (group A) or absence (group B) of respiratory symptoms. We assessed the frequency of abnormal chest X-rays and chest computed tomography (CT) scans and their impact on antimicrobial treatment decisions.
Of the 412 febrile episodes in 259 patients, 41.4% in group A and 16.1% in group B had an abnormal chest X-ray ( < .001). X-rays showing infiltrates were followed by chest CT in 51.5%. Antimicrobial treatment decisions were rarely based on results of X-rays: 6.9% (95% confidence interval [CI], 2.4%-15.6%) in group A and 3.4% (95% CI, 1.9%-5.7%) in group B ( = .200). In group A, however, antimicrobial treatment was more often adjusted based on an ensuing abnormal CT: 17.2% (95% CI, 9.2%-28.4%) versus 6.2% (95% CI, 4.0%-9.1%) ( = .004).
Chest X-rays rarely influence antibiotic treatment decisions in febrile neutropenia and can probably be safely omitted, especially in patients without respiratory symptoms.
在发热性中性粒细胞减少的血液病患者中，经常进行胸部X光检查以排除可能的肺部感染。然而，这种影像学检查的诊断和治疗价值仍不清楚。
我们进行了一项为期2年的回顾性观察队列研究，检查接受骨髓抑制化疗的成年患者发热性中性粒细胞减少的发作情况。发热发作根据是否存在呼吸道症状分为两组（A组：有呼吸道症状；B组：无呼吸道症状）。我们评估了胸部X光和胸部计算机断层扫描（CT）异常的频率及其对抗菌治疗决策的影响。
259例患者的412次发热发作中，A组41.4%、B组16.1%的胸部X光检查异常（P<0.001）。显示浸润的X光检查后有51.5%进行了胸部CT检查。抗菌治疗决策很少基于X光检查结果：A组为6.9%（95%置信区间[CI]，2.4%-15.6%），B组为3.4%（95%CI，1.9%-5.7%）（P = 0.200）。然而，在A组中，抗菌治疗更常根据随后的CT异常进行调整：17.2%（95%CI，9.2%-28.4%）对6.2%（95%CI，4.0%-9.1%）（P = 0.004）。
胸部X光检查很少影响发热性中性粒细胞减少患者的抗生素治疗决策，可能可以安全地省略，尤其是在没有呼吸道症状的患者中。
