Characteristics of adult patients with febrile neutropenia in a university hospital (Medellin, 2012-2016).
Main Article Content
Abstract
Objective: Febrile neutropenia is a condition present in patients with some degree of immunosuppression associated to oncology treatment, which leads to risks of infectious complications and death. The aim of this research is to describe the clinical, microbiological and prognostic characteristics in patients with febrile neutropenia in a university hospital.
Methodology: Retrospective cohort study developed between January of 2012 and June of 2016 in patients with febrile neutropenia (neutrophils 38.3 °C), who were hospitalized in the Pablo Tobon Uribe Hospital of Medellin, Colombia.
Results: 226 patients were evaluated, 96% of who had an oncological diagnostic. The main infectious sources were the skin and the gastrointestinal tract. Blood cultures were positive in 31%. The main pathogen was Escherichia coli in 26% and the overall hospital mortality rate was 17%.
Conclusions: The clinical characteristics of our population were similar to the national and international reports, but we found epidemiological differences in microbiological agents, bacterial resistance and mortality. Only one third of the patients presented bacteremia. E. coli remains the main pathogen involved.
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References
Mokart D, Saillard C, Chow-Chine BJ. Febrile neutropenia in onco-hematology patients hospitalized in Intensive Care Unit. Bull Cancer. 2015;102(4):349-359.
Henriquez-Camacho CV. Treatment of febrile neutropenia and prophylaxis in hematologic malignancies. Adv Hematol. 2014;2014:986938.
Shang J, Owolabi D. A comparison of ED and direct admission care of cancer patients with febrile neutropenia. Am J Emerg Med. 2015;33(7):966-969.
Godara H, Rosenstock AH. Urgencias oncológicas: Neutropenia febril. En: Manual Washington de terapéutica médica. 34.a ed. España: Lippincott Williams and Wilkins. Wolters Kluwer Health; 2014. p. 838.
Health NI. Common terminology criteria for adverse events (CTCAE) [Internet]. U.S. Department of health and human services, National cancer institute; 2010. Disponible en: https://ctep.cancer. gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_8.5x11.pdf.
Davie A. Best practice in measurement of body temperature. Nurs stand. 2010;24:42.
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(4):e56-93.
Ministerio de Salud colombiano. resolución 8430 [Internet]. 1993. Disponible en: https://www. minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
Vandenbroucke, J. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration. Ann Intern Med. 2007;147(8):W163-194.
Mukoyama N. Retrospective survey and evaluation of first-line antibiotics for chemotherapyinduced febrile neutropenia in patients with acute myeloid leukemia. Nagoya J Med. 2017;17(79):17-18.
Pizzo, PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med. 1993;328:1323.
Villela L, González-Leal XJ. Aislamientos microbiológicos en pacientes con neutropenia febril. ¿Es apropiado el uso de las guías clínicas internacionales en México? Rev Hematol Mex. 2013;14:113-119.
Lakshmaiah KC. Febrile neutropenia in hematological malignancies: Clinical and microbiological profile and outcome in high risk patients. J Lab Physicians. 2015;2(7):116-120.
Madrid C. Epidemiología de la neutropenia febril en pacientes adultos con neoplasia hematológica, en un período de 26 meses en el Hospital Pablo Tobón Uribe, Colombia. Rev Chilena Infecto. 2013;30(2):195-201.
Karanwal AB. Review of clinical profile and bacterial spectrum and sensitivity patterns of pathogens in febrile neutropenic patients in hematological malignancies: A retrospective analysis from a single center. Indian J Med and Pediatric Oncol. 2013;2(34):85-88.
Lee DG, Lee JH. Increase in antibiotic-resistant Gram-negative bacterial infections in febrile neutropenic children. J Infect Chemother. 2016;3(48):181-189.
Cattaneo C. Recent changes in bacterial epidemiology and the emergence of fluoroquinoloneresistant Escherichia coli among patients with haematological malignancies: Results of a prospective study on 823 patients at a single institution. J Antimicrob Chemother. 2008;61(3):721- 728.
Rabagliati R. Epidemiología de neutropenia febril en pacientes adultos con leucemia aguda y linfoma. Estudio de cohorte en hospitales público y privado de Santiago, Chile. Rev Chilena Infectol. 2914;6(31):71-79.
Roila NJ. Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Onco. 2016;21(5):21-29.
Ramphal R. Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. 2004;39(1):32-40.
Epidemiology of bacteremia and factors associated with multi-drug-resistant gramnegative bacteremia in hematopoietic stem cell transplant recipients. Bone Marrow Transplant. 2017;39:775–781.
Instituto nacional de cancerología. Guía de práctica clínica para el diagnóstico y tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo [Internet]. 2016. Disponible en: http:// www.cancer.gov.co/images/pdf/Guias/Guias%20de%20Practica%20Clinica/(GPC)-CompletaNeutropenia-Febril.pdf
Crawford J, Kuderer ND. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Bull cancer. 2006;106:2258-2266.
Rivera D, Brown J. The emergency care of patients with cancer: Setting the research agenda. Ann Emerg Med. 2016;2:93-101.
