Etiology of febrile neutropenia episodes among cancer patients from Hospital Clinico Universidad Catolica, Santiago-Chile

Abstract

The surveillance of febrile neutropenia (FN) episodes in every center allows adapt the antibiotic therapy guidelines to local epidemiology. To characterize clinical features and compare the FN etiology between hematological cancer (HC) and solid organ cancer (SOC) in our center. Surveillance study in adult patients with FN admitted to Hospital Clinico Universidad Católica, in Santiago, Chile, from January 2004 to August 2007. 154 FN episodes corresponding to 87 patients were included. Mean age: 47 +/- 6 years-old; 71% had HC and 29% SOC. A clinical and/or microbiologically documented infection was recognized in 76%. Gastrointestinal 31.5%, upper respiratory 30.3% and lower respiratory 16.9% were the more frequent clinical focus. In 30.5% blood culture resulted positive: gram negative rods 51%, gram positive cocci 41% and yeasts 8%; being Escherichia coli 22%, S. coagulase negative (SCoN) 20% and Klebsiella pneumoniae 12% most frequent bacteria; 22.2% Enterobacteriaceae were ESBL producers and 55.6% 5CoN were methicillin resistant. In 18.3% of FN episodes the etiology was not established. Highest mortality was observed in episodes with microbiologically documented infection (14.5% vs 1.3%, p < 0.005). A clinical observed focus and positive blood cultures were more frequently obtamed among HC than SOC associated episodes: 37.3% vs 13.6%; (p < 0.01) and 67.2% vs 50%; (p = 0.045), respectively. The etiological profile of FN in our center and the necessity to continue the surveillance was described. Future studies are needed regarding risk factors of invasive infection that have worst prognosis.