Outcome of severe infections in afebrile neutropenic cancer patients

Abstract

BackgroundIn some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia.Patients and methodsWe retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test.ResultsWe identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17).ConclusionsAfebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy.

Occurrence of influenza and bacterial infections in cancer patients receiving radiotherapy in Ghana

“…There was a relatively high prevalence of respiratory pathogens and high incidence of ARI. The univariate analysis conducted indicated that, the presence of a pathogen correlated well with at least one of the ARI-like symptoms which is similar to other studies from different countries [ 3 , 24 , 28 , 29 ]. Additionally, the high prevalence (61%) of bacteria in this study confirms the findings of Margolis and colleagues [ 30 ] which suggests that, these pathogens interact with one another in a common niche, hence may co-colonize.…”

“…and Strojnik et al . also demonstrated that fever may be absent in some cancer patients regardless of microbiologically and/or clinically confirmed infections [ 27 , 28 ].…”

<p>Prevalence of Extended-Spectrum Beta-Lactamase-Producing <em>Enterobacteriaceae</em> Causing Bloodstream Infections in Cancer Patients from Southwest of Iran</p>

“…1 The most common outcome of chemotherapeutic agents is neutropenia that could lead to the severity of bacterial infections in patients suffering from cancer. 2 Correspondence: Morteza Saki; Sakineh Seyed-Mohammadi Tel +98 9364221187; +98 9352655807 Fax +98 6133332036 Email mortezasaki1981@gmail.com; sakinehseyedmohammadi@gmail.com…”

Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

“…For example, FN patients can present acutely but insidiously where fever is the only manifestation of severe underlying infection (Kao et al, 2018). Previous studies also identified that one-third of neutropenic patients could be afebrile when presenting to the ED but had significantly higher 30 day in-hospital mortality rates than FN patients (Freifeld et al, 2011;Strojnik et al, 2016). Therefore, this harmful emergency can go unnoticed despite the illness's severity and deteriorates to sepsis and septic shock.…”