Researchers Characterize Epidemiology of, Source of Infection in Febrile Neutropenia

Seeking to provide more insight into the epidemiology and source of infection in patients with febrile neutropenia, researchers have determined that febrile neutropenia has a low rate of bacteremia and approximately half of patients receive the recommended initial empiric therapy.

Over a 9-year period (2006-2015), the researchers extracted data from records on 231 patients with febrile neutropenia admitted to a 350-bed hospital.

Among the patients, there were 372 episodes of febrile neutropenia, with hematological malignancies accounting for 56.6% of the episodes. Approximately 1 in 3 of the episodes had central venous catheters.

Examining the positive blood cultures, which were present in 13.5% of episodes, the researchers found that both gram-negative bacilli and gram-positive cocci were each present in 5% of all episodes.

“It’s interesting to note that there was a small number of patients who had candidemia during the episodes of febrile neutropenia,” wrote the researchers. The annual incidence of the infection ranged from 0.2-0.76/1000 hospital discharges and 0.45-1.6/1000 patient-days per year.

According to the researchers, the most common sites of infection were blood (10.8%) and pulmonary (9.2%), while the majority (72.5%) had no identifiable source of infection.

Over the 9-year period, the mortality rate was 11.2%. “A comparison between those who survived and those who died showed that mortality was significantly associated with the presence of bacteremia (24.4% verses 12.4% in the absence of bacteremia),” explained the researchers, who added that there was no significant association between mortality and age, type of malignancy, presence of central venous catheter, or severity of neutropenia.

Compared with patients with hematological malignancies, patients with solid organ malignancies were more likely to be female (62% vs 14.9%) and were less likely to have bacteremia (8.7% vs 17.1%).

The most commonly used single antimicrobial agents were imipenem (38%) and ceftazidime (7.5%), resulting in a 45.5% compliance rate with single antimicrobial therapy. The remaining patients received variable combination therapy. According to the researchers, the variability in the compliance rate with recommended therapy could potentially be a result of patients’ characteristics, the presence of previous antibiotic resistance, or the severity of neutropenia.

Reference

Al-Tawfiq J, Hinedi K, Khairallah H, et al. Epidemiology and source of infection in patients with febrile neutropenia: a ten-year longitudinal study [published online December 26, 2018]. doi: 10.1016/j.jiph.2018.12.006.