A Retrospective Study of Febrile Neutropenia From a Cancer Hospital

Abstract

Background Fever in neutropenic patients is considered an emergency medical condition, requiring early recognition and prompt management. The aims of this study were to find the pathogen and time to antibiotic administration, and to identify predictive factors of mortality in patients with febrile neutropenia. Methods We retrospectively reviewed the clinical manifestations, pathogenic organisms, treatment regimens, and 30-day mortality of febrile neutropenic adult patients with solid tumor admitted to a cancer hospital in Thailand from January 2014 to December 2019. Results We enrolled 96 episodes of febrile neutropenia. Median age was 53 years. Sixty-two patients (64.6%) were female. The 2 most common cancers were head and neck (31.2%), followed by breast (30.2%), and 69.8% of all patients were in the advanced stage. Seven patients (7.3%) died within 30 days after onset. Bacteremia occurred in 7 episodes (7.8%). Source of infection was identified in 21 patients (21.8%). Gram-negative organism accounted for 85% of bacteremia and 79% of isolated pathogen. Pseudomonas aeruginosa was the most frequently identified causative organism. The most common empirical antibiotic was ceftazidime (67.7%). Median time to antibiotic administration was significantly shorter for nonsurvivors (32.5 minutes) than for survivors (62.0 minutes; P = 0.031). In the multivariate analysis, sepsis (odd ratio, 10.74; 95% confidence interval, 1.93–59.73; P = 0.007) was associated with increased 30-day mortality. Conclusions Gram negative was the predominant pathogen of neutropenic patients in this study. Shorter time to antibiotic administration did not contribute to a better outcome. Sepsis was an unfavorable predictive factor of death.