Abstract
Infections still remain the major cause of morbidity and mortality in neu-tropenic patients with leukemia. Especially fungal infections are critical during neutopenia. 487 febrile phases were evaluated retrospectively during 377 neutropenic episodes (leukocytes < 0.5×10<sup>9</sup>/l) of 182 AML-patients treated in our institution from 1982–1993. We observed 16 neutropenic phases without fever. In 156 episodes (32%) the origin remained unknown (FUO), but 331 (68%) were clinically or microbio-logically identified infections mostly gram-positive bacterial (37%), followed by fungal (31%) and gram-negative bacterial infections (21%). Sepsis (220) and pneumonia (86) represented the major type of infections. 70% of pneumonia were caused by fungi. Urinary tract infections (27), tonsillitis (17), oesophagitis (16) and abscesses (13) turned out to be the other main infection sites. 48 patients died during neutropenia. The leading cause of death was fungal sepsis or pneumonia in 73% (29). 38% (11) of lethal fungal infections were discovered at autopsy; in 9 of these 11 patients mixed infections were observed—frequently a combination of fungal and gram-negative infection. To conclude all patients with pneumonia in neutropenia should be treated early with high dosage antimycotic therapy; in addition a mixed infection should be considered.
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