Neutropenia febril in the elderly: focus on bacteriemia

Abstract

Background: Febrile neutropenia (FN) represents an infectious urgency in cancer patients, mainly in those with chemotherapy treatment. Bacteremia is the most important cause of severe infections and responsible for significant morbidity and mortality. Currently evidence-based data for NF management in elderly patients is scarce because of the underrepresentation in studies. We present the analysis of a cohort of elderly population in a reference center. The aim of this study was to describe characteristics and prognosis of bacteremia in elderly patients with FN. Methods & Materials: We conducted a descriptive, retrospective study including all cancer patients with FN, aged ≥65 years, admitted between 2014-2016. Clinical and epidemiological variables of FN events with bacteremia were reviewed and analyzed: microbiological isolates, antimicrobial resistance and mortality. The X2 test was used as a statistical method (p < 0.05). Results: We evaluated 71 episodes of FN corresponded to 47 patients, with an average age of 72 (±6,49) years. 84% had a diagnosis of oncohematological disease, being acute myeloid leukemia (47%) the most frequent. The 30-day overall mortality was 29.57%. 22 episodes (31%) were culture-positive for bacteriemia. Of this, 64% were hospital-acquired infection with a median of 7.5 (7.5-14) days of hospitalization from the day of admission to the FN episode. The most common pathogens isolated were gram negative bacilli (GNB) in 68% (n:15/22) (K pneumoniae 42%), followed by gram positive cocci (GPC) with 28% (n:6/22) (S. epidermidis 83%). Methicillin resistance was found in 67% of GPC, and 40% of GNB expressed ESBL production. No statistically significant associations were found in antimicrobial resistance of isolated microorganisms between hospital-acquired and community-acquired infections (test X2 = 0.10, p = 0.74). Four patients (18%) died within 14 days after bacteremia onset. Conclusion: In this study, mortality rate in patients with FN and bacteremia were found to be similar to the published in the literature, whereas the overall mortality rate of NF events was higher. The importance of knowing the profiles of antimicrobial resistance within the institution allows us to adapt medical effort to the integral approach of this entity. This first approach opens questions that deserve the continuity of the study to clarify them.