A prospective study of febrile neutropenia in lung cancer patients

Abstract

BACKGROUND There are few data on microbiology of febrile neutropenia (FN) in lung cancer patients. The primary objective of this study was to evaluate the epidemiology of FN in this population. PATIENTS AND METHODS All patients with lung cancer treated with chemotherapy in the Institut Jules Bordet (a cancer hospital) and who developed FN (PMN <500/mm3) were included in the present prospective study. Febrile neutropenia was defined as any febrile episode (38.5°C once or 38.0°C twice) occurring during neutropenia (neutrophil count <500/mm3). RESULTS Ninety five patients, 62 with non-small cell and 33 with small cell lung carcinoma developed FN. A total of 102 FN episodes were observed. Of these, 46 were microbiologically and 14 clinically documented. The most frequent site of infection was the lung (31%). Gram-negative bacteria, mainly Escherichia coli and Haemophilus influenzae, were most commonly observed. In bacteremic patients, Gram-positive bacteria, essentially Streptococcus sp, Enterococcus sp and Staphylococcus aureus, accounted for 39% of the micro-organisms. CONCLUSION Lung constitutes the predominant site of infection in febrile neutropenic lung cancer patients. In these patients, E. coli and H. influenzae are the most commonly documented pathogens, except in case of bacteremia where Streptococcus sp and S. aureus as well as E. coli are the principal pathogens. I N T R O D U C T I O N Infection is one of the commonest complications associated with cancer. Different factors are contributing: immunosuppression related to cancer or its treatment, visceral neoplastic obstruction, use of implantable devices and invasive procedures, disruption of physiological barriers or blood product transfusion [1]. In lung cancer patients neutropenia, chronic obstructive bronchopulmonary disease (COPD) and bronchial obstruction are probably the main causes favouring infection. Epidemiological data on infections in lung cancer patients are scarce. We have previously reported a prospective epidemiological study demonstrating that the majority of lung infections were predominantly due to Gram negative bacteria [2]. Few other studies have assessed the respective frequency of the infection types and microbiology in these patients, also demonstrating that infections occur essentially in the lung. Chemotherapy is now generally accepted as part of the treatment of patients with lung cancer, whatever stage or histology are considered [3-5]. Chemotherapy is ORIGINAL ARTICLE HOSPITAL CHRONICLES 2007, 2(1): 38–43 Address for correspondence: Dr T. Berghmans Institut Jules Bordet Rue Hιger-Bordet, 1 1000 Bruxelles Belgium Tιl: +322.5413191 Fax: +322.5343756 e-mail: thierry.berghmans@bordet.be KEy-wORDS: febrile neutropenia, microbiology, non-small cell lung cancer, small cell lung cancer, epidemiology, risk