Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients

Abstract

Febrile neutropenic cancer patients are at risk for development of serious infections, morbidity and mortality. The aim of this study was to determine the type and frequency of infections and to evaluate some prognostic risk factors. 220 episodes of neutropenic fever in 177 cancer patients have been reviewed. Infections could be documented microbiologically in 38 (17.3%) episodes and suspected clinically in 29 (13.2%). The most common focus of infection was the lower respiratory tract (11.4%) followed by the urinary tract (6.4%). The most frequently isolated pathogen was Escherichia coli (31%) followed by Klebsiella pneumoniae (18%), Pseudomonas aeruginosa (13%) and Streptococcus pneumoniae (13%). The median durations of neutropenia and fever were 4 and 3 days, respectively. Mortality was seen in 25 patients (11.4%). Its rate was higher in documented infections except for non-bacteremic microbiologic infections in which no death was seen. Hypotension and shock were the most significant determinants of poor prognosis. The management of these special patients should be given adequate attention and be considered important since the success of therapy depends on revealing of etiologic agents.