Results of high-risk neutropenia therapy of hematology–oncology patients in a university hospital in Uruguay

Abstract

BackgroundFebrile neutropenia is an important cause of mortality and morbidity in hematology–oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia.MethodsA retrospective cohort study (2011–2012) was conducted of patients with high-risk neutropenia in a hematology–oncology service.ResultsForty-four episodes of 17 patients with a median age of 48 years (range: 18–78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia isolated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%.ConclusionThe high rate of gram-negative bacilli resistant to piperacillin/tazobactam (front-line antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol.

Chemotherapy-induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences

“…These findings had been described in a historical review (34), and were confirmed in a recent study (8), where the extent and duration of neutropenia were significantly associated with the risk of infection.…”

“…CIN and related complications have an economic impact on health care providers (8). The mean cost for each neutropenia episode in our service was 9,386.5±6,688.9 Egyptian pounds, which was significantly lower compared with those reported in different economic analyses (39)(40)(41).…”

“…Similarly, FN was the most commonly recorded complication (61.4%) of systemic chemotherapy for hematological oncology adult patients in a recent study conducted in Uruguay (8). By contrast, Mahmud et al reported a significantly lower incidence (25-40%) of FN in their series (31).…”

“…Respiratory tract and skin infections were the most common according to Boada Burutaran et al (8), while Anunnatsiri et al reported urinary tract infection, soft tissue infection and bacteremia as the most common occurrences (32). Variable sites of infections may be associated with different invasive procedures that provide a portal of entry for pathogens (18).…”

“…Early recognition of FN and initiation of broad spectrum empirical systemic antibacterial therapy is crucial for avoiding progression to sepsis and possible death (7). CIN may also necessitate chemotherapy dose reductions, delays or even discontinuation, which may compromise treatment outcome (8).…”