Secondary Infections in Cancer Patients with Febrile Neutropenia

Abstract

Objective: patients with neutropenia due to cancer chemotherapy are prone to severe infections. Cancer patients can experience >1 infectious episode during the same period of neutropenia. This study aimed to determine the etiological and clinical characteristics of secondary infectious episodes in cancer patients with febrile neutropenia and to identify the factors associated with the risk of secondary infectious episodes.Material and Methods: All cancer patients that received antineoplastic chemotherapy at Ankara University, School of Medicine, Department of Hematology between May 2004 and May 2005 and developed neutropenia were included in the study. Data were collected using survey forms that were completed during routine infectious diseases consultation visits. Categorical data were analyzed using the chi-square test, whereas Student's t-test was used for continuous variables. Multivariate logistic regression analysis was performed to identify independent predictors of secondary infections (SIs).Results: SIs were observed during 138 (53%) of 259 febrile neutropenic episodes. Of the 138 episodes, 89 (64.5%) occurred in male patients with a mean age of 40.9 years (range: 17-76 years). In total, 80% of the SIs were clinically or microbiologically documented. Factors on d 4 of the initial febrile episode were analyzed via a logistic regression model. The presence of a central intravenous catheter (OR: 3.01; p < 0.001), acute myeloid leukemia (AML) as the underlying disease (OR: 2.12; p = 0.008), diarrhea (OR: 4.59; p = 0.005), and invasive aspergillosis (IA) during the initial febrile episode (OR: 3.96; p = 0.009) were statistically significant risk factors for SIs. Conclusion: Among the cancer patients with neutropenia in the present study, AML as the underlying disease, the presence of a central venous catheter, diarrhea, and IA during the initial febrile episode were risk factors for the development of SIs.

Secondary infections after cytotoxic chemotherapy in patient with hematological malignancies

“…However, acute leukemia as the underlying disease, salvage chemotherapy for refractory/relapse diseases, low MASCC score, duration of neutropenia (≥ 10 days), and fungal infection during the primary episode were found to be risk factors associated with secondary infections. These findings support our current information that acute leukemia, refractory/relapse diseases, and low MASCC score are risk factors for primary or secondary infection [7,8,15]. It is also not surprising that prolonged neutropenia and fungal infection during primary episodes increase the risk of secondary infection [8,19], because the prolonged duration of neutropenia is one of the most important risk factors for fungal infections [7,20].…”

“…However, patients with fungal infection are also frequently prolonged neutropenic patients. As in the current study, invasive aspergillosis during primary episodes was found to be a risk factor for secondary infection in a study published by Azap et al [15]. Common use of antibiotics before a febrile episode, use of broad-spectrum antibiotics during febrile episodes, and relatively lower prophylactic antifungal usage greatly increase the risk of fungal infection in these patients.…”

“…Contrary to general literature data, Azap et al reported a very high secondary infection rate (138/259 [53%] FNEs) [15]. They emphasized that this high rate could be associated with the underlying disease of patients and the chemotherapeutic regimen.…”

“…In another study, the presence of central venous catheter (CVC), acute myelogenous leukemia (AML) as the underlying disease, diarrhea, and invasive aspergillosis during primary infections were reported to be risk factors for secondary infections [15]. Using multivariate analysis, Nucci et al showed four independent risk factors for secondary infection, which included a longer duration of severe neutropenia, lack of use of prophylactic quinolones, persistence of fever on day 4 of the initial regimen, and use of CVC [9].…”

Differences in characteristics between first and breakthrough neutropenic fever after chemotherapy in patients with hematologic disease

“…3 Appropriate antibiotic treatment was defined as treatment matching the in vitro susceptibility of subsequently isolated bacteria. 8 The following Gram-negative bacteria were considered to be multidrug-resistant (MDR): (1) MDR strains of Pseudomonas aeruginosa and Acinetobacter baumannii resistant to at least three classes of antibiotics: carbapenems, ureidopenicillins, cephalosporins, monobactams, aminoglycosides, and fluoroquinolones; (2) extended-spectrum beta-lactamase (ESBL)producing Enterobacteriaceae. 13…”