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CC BY-NC-ND 4.0 · J Lab Physicians 2015; 7(02): 116-120
DOI: 10.4103/0974-2727.163126
Original Article

Febrile Neutropenia in Hematological Malignancies: Clinical and Microbiological Profile and Outcome in High Risk Patients

Kuntegowdanahalli C Lakshmaiah
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Abhayakumar S Malabagi
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Govindbabu,
Rachan Shetty
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Mahua Sinha
Department of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Rudrapatna S Jayashree
Department of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
› Author Affiliations Source of Support: Nil.
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ABSTRACT

Background and Objectives: Febrile neutropenia (FN) is considered a medical emergency. Patients with hematological malignancies (HM) commonly experience FN. Broad spectrum antibiotics have to be started empirically to prevent complications. This study depicts the clinical profile, microbiological profile, antibiotic sensitivity pattern, and outcome in high risk HM.

Materials and Methods: In this prospective study, 72 patients with hematologic malignancies, diagnosed and treated for 108 high risk febrile neutropenic episodes from August 2011 to January 2013 at a Regional Cancer Center, in South India were analyzed. Cefoperazone-sulbactum was used as a first-line empiric antibiotic.

Results: Majority of the patients with FN episodes had acute myeloid leukemia. Overall culture positivity was 29.62%. The most common organisms isolated were Gram-negative bacilli (63.64%), with Escherichia coli being the most frequent pathogen. All Gram-negative organisms were sensitive to imipenem, whereas sensitivity pattern to other antibiotics were as follows: 85.71%, 78.26%, 69.52%, 63.64%, 41.66% and 47.05% for pipercillin-tazoactum, meropenem, cefoperazone-sulbactum, amikacin, ceftazidime, ciprofloxacin respectively. Overall mortality was 13.5%. Most of the patients responded to empiric antibiotic cefoperazone-sulbactum.

Conclusions: In the hematologic malignancies particularly in acute leukemia, there is high risk of developing FN. Empiric therapy with cefoperazone-sulbactum as a first line leads to satisfactory outcome in high risk FN and therapy should be tailored to the most appropriate antibiotics according to the bacterial culture results.

Keywords

Antibiotics - febrile neutropenia - Gram-negative organism - hematological malignancies - treatment


Publication History

Article published online:
19 April 2020

© 2015.

Thieme Medical and Scientific Publishers Private Ltd.
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  • REFERENCES

  • 1 Freifeld AG, Walsh TJ, Pizzo PA. Infectious complications in the pediatric cancer patient. In: Pizzo PA, Poplack DG, editors. Principles and Practice of Pediatric Oncology. Philadelphia: Lippincott-Raven; 1997 p. 1069-114.
  • 2 Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730-51.
  • 3 Lyman GH, Dale DC, Friedberg J, Crawford J, Fisher RI. Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin's lymphoma: A nationwide study. J Clin Oncol 2004;22:4302-11.
  • 4 Kang CI, Kim SH, Kim HB, Park SW, Choe YJ, Oh MD, et al. Pseudomonas aeruginosa bacteremia: Risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis 2003;37:745-51.
  • 5 Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006;106:2258-66.
  • 6 Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011;52:e56-93.
  • 7 Ghosh I, Raina V, Kumar L, Sharma A, Bakhshi S, Thulkar S, et al. Profile of infections and outcome in high-risk febrile neutropenia: Experience from a tertiary care cancer center in India. Med Oncol 2012;29:1354-60.
  • 8 Cordonnier C, Herbrecht R, Pico JL, Gardembas M, Delmer A, Delain M, et al. Cefepime/amikacin versus ceftazidime/amikacin as empirical therapy for febrile episodes in neutropenic patients: A comparative study. The French Cefepime Study Group. Clin Infect Dis 1997;24:41-51.
  • 9 Advani SH, Kochupillai V, Lalitha N, Shanta V, Maitreyan V, Nair R, et al. Infections in the immunocompromised host: A prospective multicenter survey in patients receiving chemotherapy for acute leukemia. J Assoc Physicians India 1996;44:769-73.
  • 10 Jagarlamudi R, Kumar L, Kochupillai V, Kapil A, Banerjee U, Thulkar S. Infections in acute leukemia: An analysis of 240 febrile episodes. Med Oncol 2000;17:111-6.
  • 11 Talcott JA, Siegel RD, Finberg R, Goldman L. Risk assessment in cancer patients with fever and neutropenia: A prospective, two-center validation of a prediction rule. J Clin Oncol 1992;10:316-22.
  • 12 Srivastava VM, Krishnaswami H, Srivastava A, Dennison D, Chandy M. Infections in haematological malignancies: An autopsy study of 72 cases. Trans R Soc Trop Med Hyg 1996;90:406-8.
  • 13 Yadegarynia D, Tarrand J, Raad I, Rolston K. Current spectrum of bacterial infections in patients with cancer. Clin Infect Dis 2003;37:1144-5.
  • 14 Zinner SH. Changing epidemiology of infections in patients with neutropenia and cancer: Emphasis on gram-positive and resistant bacteria. Clin Infect Dis 1999;29:490-4.
  • 15 Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 2003;36:1103-10.
  • 16 Viscoli C, Varnier O, Machetti M. Infections in patients with febrile neutropenia: Epidemiology, microbiology, and risk stratification. Clin Infect Dis 2005;40 Suppl 4:S240-5.
  • 17 Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: A three-year analysis. Clin Infect Dis 1999;29:239-44.
  • 18 Rubio M, Palau L, Vivas JR, del Potro E, Diaz-Mediavilla J, Alvarez A, et al. Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol 1994;15:101-4.
  • 19 Madiajagane R. A retrospective study of infections in neutropenic patients. J Indian Med Assoc 1998;96:239-40, 244.
  • 20 Kumar L, Kochupillai V, Bhujwala RA. Infections in acute myeloid leukemia. Study of 184 febrile episodes. J Assoc Physicians India 1992;40:18-20.
  • 21 Das PK, Chhotaray MK, Rath RN, Kar S, Das B, Parida B. Infection in haematological malignancies. J Indian Med Assoc 1994;92:328-30.
  • 22 Swati M, Gita N, Sujata B, Farah J, Preeti M. Microbial etiology of febrile neutropenia. Indian J Hematol Blood Transfus 2010;26:49-55.
  • 23 Kumar P, Medhekar A, Ghadyalpatil NS, Noronha V, Biswas S, Kurkure P, et al. The effect of age on the bacteria isolated and the antibiotic-sensitivity pattern in infections among cancer patients. Indian J Cancer 2010;47:391-6.
  • 24 Schimpff SC, Young VM, Greene WH, Vermeulen GD, Moody MR, Wiernik PH. Origin of infection in acute nonlymphocytic leukemia. Significance of hospital acquisition of potential pathogens. Ann Intern Med 1972;77:707-14.