Blood Absolute Neutrophil Count Research Articles

The effect of a selective CXCR2 antagonist (AZD5069) on human blood neutrophil count and innate immune functions.

The aim of the present study was to investigate whether selective antagonism of the cysteine-X-cysteine chemokine receptor-2 (CXCR2) receptor has any adverse effects on the key innate effector functions of human neutrophils for defence against microbial pathogens. In a double-blind, crossover study, 30 healthy volunteers were randomized to treatment with the CXCR2 antagonist AZD5069 (100 mg) or placebo, twice daily orally for 6 days. The peripheral blood neutrophil count was assessed at baseline, daily during treatment and in response to exercise challenge and subcutaneous injection of granulocyte-colony stimulating factor (G-CSF). Neutrophil function was evaluated by phagocytosis of Escherichia coli and by the oxidative burst response to E. coli. AZD5069 treatment reversibly reduced circulating neutrophil count from baseline by a mean [standard deviation (SD)] of -1.67 (0.67) ×10(9) l(-1) vs. 0.19 (0.78) ×10(9) l(-1) for placebo on day 2, returning to baseline by day 7 after the last dose. Despite low counts on day 4, a 10-min exercise challenge increased absolute blood neutrophil count, but the effect with AZD5069 was smaller and not sustained, compared with placebo treatment. Subcutaneous G-CSF on day 5 caused a substantial increase in blood neutrophil count in both placebo- and AZD5069-treated subjects. Superoxide anion production in E. coli-stimulated neutrophils and phagocytosis of E. coli were unaffected by AZD5069 (P = 0.375, P = 0.721, respectively vs. baseline, Day 4). AZD5069 was well tolerated. CXCR2 antagonism did not appear adversely to affect the mobilization of neutrophils from bone marrow into the peripheral circulation, phagocytosis or the oxidative burst response to bacterial pathogens. This supports the potential of CXCR2 antagonists as a treatment option for diseases in which neutrophils play a pathological role.

Hematological Indices at Birth of Infants of HIV-Positive Mothers Participating in a Prevention of Mother-to-Child Transmission Program.

The mother-to-child transmission of HIV, which accounts for 90% of infections in children, has been reduced markedly through the use of antiretroviral drugs by pregnant women and their newborns. Changes to the World Health Organization guidelines support further extension of the prevention of mother-to-child transmission programs with increased risk of toxicity on the fetuses. To determine the hematological indices at birth of infants exposed in utero to maternal antiretroviral drugs. A comparative analytical study of 126 neonates whose blood samples were analyzed to determine their hematological indices. The hemoglobin, hematocrit, the total white blood cell (WBC) count and absolute neutrophil count (ANC) were significantly lower in infants of HIV-positive mothers. The total WBC and ANC were also significantly lower in the highly active antiretroviral therapy. HAART group and those exposed to maternal drugs for <1 year. There are significant changes in the hematological indices of infants of HIV-positive mothers at birth.

P53-Based strategy to reduce hematological toxicity of chemotherapy: A proof of principle study

p53 activation is a primary mechanism underlying pathological responses to DNA damaging agents such as chemotherapy and radiotherapy. Our recent animal studies showed that low dose arsenic (LDA)-induced transient p53 inhibition selectively protected normal tissues from chemotherapy-induced toxicity.Study objectives were to: 1) define the lowest safe dose of arsenic trioxide that transiently blocks p53 activation in patients and 2) assess the potential of LDA to decrease hematological toxicity from chemotherapy.Patients scheduled to receive minimum 4 cycles of myelosuppressive chemotherapy were eligible. For objective 1, dose escalation of LDA started at 0.005 mg/kg/day for 3 days. This dose satisfied objective 1 and was administered before chemotherapy cycles 2, 4, and 6 for objective 2. p53 level in peripheral lymphocytes was measured on day 1 of each cycle by ELISA assay. Chemotherapy cycles 1, 3, and 5 served as the baseline for the subsequent cycles of 2, 4, and 6 respectively. If p53 level for the subsequent cycle was lower (or higher) than the baseline cycle, p53 was defined as “suppressed” (or “activated”) for the pair of cycles. Repeated measures linear models of CBC in terms of day, cycle, p53 activity and interaction terms were used.Twenty-six patients treated with 3 week cycle regimens form the base of analyses. The mean white blood cell, hemoglobin and absolute neutrophil counts were significantly higher in the “suppressed” relative to the “activated” group.These data support the proof of principle that suppression of p53 could lead to protection of bone marrow in patients receiving chemotherapy.This trial is registered in ClinicalTrials.gov. Identifier: NCT01428128.

Derived neutrophil lymphocyte ratio may predict benefit from cisplatin in the advanced biliary cancer: the ABC-02 and BT-22 studies

The superiority of cisplatin and gemcitabine (CisGem) chemotherapy over gemcitabine (Gem) alone in patients with advanced biliary tract cancer (ABC) has been demonstrated in two randomised trials; ABC02 and the Biliary Tract (BT) 22 study. We used a combined dataset from these two trials to investigate the derived neutrophil-to-lymphocyte ratio (dNLR), which is thought to be a prognostic factor associated with clinical outcomes in several solid tumours, including ABC. White blood cell (WBC) and absolute neutrophil count (ANC) were available for 379 of 410 patients from ABC-02 and all 83 patients in BT-22. The dNLR was calculated as ANC/(WBC-ANC), as previously specified. We examined the association between dNLR and overall survival (OS) and progression-free survival (PFS), as well as comparing the treatment effect in two patient groups defined by their dNLR level. A high dNLR was defined as ≥3.0, which was approximately the upper tertile value. A total of 462 individual patient records were analysed, 328 with baseline dNLR <3 and 134 with dNLR ≥3. There were 443 deaths in the cohort, and all surviving patients had a dNLR <3. There was strong evidence that dNLR was closely associated with both OS [hazard ratio (HR), 1.62; 95% confidence interval (CI) 1.32-2.01] and PFS (HR, 1.40; 95% CI 1.13-1.72). There was limited evidence (P = 0.10) of a differential effect of CisGem on OS between the two dNLR groups, but this was clearest in the ABC-02 dataset (P = 0.06). There was good evidence (P = 0.008) of an association between low baseline dNLR and long-term survival on a CisGem regimen. There was also good evidence of an association between ECOG performance status (split at 0 and 1 versus 2) on both OS (P < 0.001) and PFS (P = 0.01), but no evidence of a differential treatment effect, with both groups receiving benefit from the addition of cisplatin. These data confirm that high dNLR is associated with worse OS and PFS, and suggests it may also be predictive of benefit for the addition of cisplatin to gemcitabine in European patients with ABC. Incorporating dNLR into the clinical context may better inform prognosis and chemotherapy decisions in ABC patients.

Effect of clozapine on immunoglobulin M plasma levels.

Effect of clozapine on immunoglobulin M plasma levels.

Longitudinal study of acute haematologic toxicity in cervical cancer patients treated with chemoradiotherapy.

Acute hematologic toxicity (HT) limits optimal delivery of concurrent chemoradiotherapy (CRT) for patients with pelvic malignancies. We tested the hypothesis that pelvic bone marrow (PBM) dose-volume metrics were associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT. We included 102 cervical cancer patients treated with concurrent cisplatin (40 mg/m(2) /week) and pelvic radiotherapy treated at three US centres. No patient received granulocyte-monocyte colony stimulating factor (GM-CSF) or platelet transfusions. Using linear-mixed effects modelling, we analysed weekly reductions in log-transformed peripheral blood cell counts as a function of time (weeks), mean PBM dose and the PBM volume receiving ≥10 Gy (V(10)), 20 Gy (V(20)), 30 Gy (V(30)) and 40 Gy (V(40)). Increases in mean PBM radiation dose, V(20), V(30) and V(40) were all significantly associated with a greater weekly reduction in white blood cell (WBC) and absolute neutrophil counts (ANCs). We estimated that with every 1 Gy increase in mean PBM dose, ln(ANC) was reduced by 9.6/μL per week (95% confidence interval, 1.9-17.3, P = 0.015). Subregion analysis also identified significant associations between weekly reductions in ln(WBC) and ln(ANC) within lumbosacral spine, ischium and proximal femora, as opposed to ilium. PBM radiation dose-volume metrics are significantly associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT, particularly within the lower pelvis and lumbosacral spine.

Co-upregulation of Toll-like receptors 2 and 6 on peripheral blood cells in patients with obstructive sleep apnea.

Toll-like receptor (TLR) 2 can heterodimerise with TLR6 to detect diacylated lipoproteins. Hypoxia inducible factor-1 α co-ordinates selective induction of TLR2 and TLR6 during persistent hypoxia. We hypothesized that TLR 2/6 co-expression may be upregulated by chronic intermittent hypoxia with re-oxygenation (IHR) in obstructive sleep apnea (OSA). TLR2/6 expressions on blood immune cells were measured in 144 patients with sleep-disordered breathing (SDB), including primary snoring (PS, n = 24), moderate to severe OSA (MSO, n = 60), very severe OSA (VSO, n = 36), and very severe OSA on continuous positive airway pressure (CPAP) treatment (VSOC, n = 24). An in vitro IHR experiment was also undertaken. Patients in both the MSO and VSO groups had increased TLR2/6 co-expression on CD16(+) neutrophil than those in the PS group. Patients in the VSOC group had reduced TLR2/6 co-expression on neutrophil than those in either the MSO or VSO group. Blood absolute neutrophil count was positively but weakly correlated with TLR2/6 co-expression on neutrophil. TLR2/6 co-expressions on both CD14(+) monocyte and CD3(+)CD4(+)T helper cell, and TLR2 expressions on both monocyte and T helper cell in SDB patients with low Minimum SaO₂ (≦70%) were all higher than those with high Minimum SaO₂. In vitro IHR for 1-4 days resulted in TLR2/6 co-upregulation on both neutrophil and monocyte. OSA patients had increased TLR2/6 co-expressions on blood immune cells, which were related to their immune cell counts and could be reversed with CPAP treatment. In vitro IHR could induce TLR2/6 co-upregulation.

Nadir White Blood Cell, Absolute Neutrophil, and Absolute Lymphocyte Counts During Concurrent Chemoradiation Therapy Are Associated With Worse Outcomes in Patients With Limited-Stage Small Cell Lung Cancer: Small Cell Lung Cancer

Nadir White Blood Cell, Absolute Neutrophil, and Absolute Lymphocyte Counts During Concurrent Chemoradiation Therapy Are Associated With Worse Outcomes in Patients With Limited-Stage Small Cell Lung Cancer: Small Cell Lung Cancer

622PD - Does the Derived Neutrophil Lymphocyte Ratio Predict Benefit from Cisplatin and Gemcitabine Compared with Gemcitabine Alone in Advanced Biliary Cancer? an Exploratory Study of the Abc-02 Trial

ABSTRACT Aim: The Advanced Biliary Cancer (ABC)-02 randomized trial demonstrated the superiority of cisplatin and gemcitabine (CisGem) chemotherapy over gemcitabine (Gem) alone in patients with advanced biliary tract cancer (ABTC). Neutrophil to lymphocyte ratio (NLR) has been shown to be a prognostic factor in advanced biliary cancer. Derived NLR (dNLR) has similar prognostic value to NLR. The aim of the current analysis was to evaluate dNLR as a predictor of the survival benefit conferred by CisGem compared with Gem alone in patients with ABTC. Methods: A post-hoc exploratory analysis of ABC-02 was performed on all patients with available white blood cell (WBC) and absolute neutrophil count (ANC) data. The dNLR was calculated using a formula that was previously shown. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate independent prognostic factors and to estimate their effects on PFS and OS. Results: WBC count and ANC were available in 322 patients: 162 patients received Gem and 160 patients received CisGem. The baseline characteristics remained balanced between the two treatment arms. dNLR was an independent prognostic factor for OS for the entire cohort (p = 0.001); A high dNLR was defined using a cutoff value of 3.0; it was selected by rounding the mean value of dNLR for the entire cohort, which was 2.94. The median OS was 6.9 months versus 10.6 months for patients with dNLR > 3.0, versus NLR Conclusions: These data suggest that dNLR has prognostic significance and may represent a clinical biomarker predicting benefit of cis/gem combination compared with gemcitabine alone in patients with ABTC. dNLR >3.0 may indicate lack of survival advantage of adding cisplatin to gemcitabine. Disclosure: All authors have declared no conflicts of interest.

Efficacy and safety of immunosuppressive therapy in the treatment of seronegative hepatitis associated aplastic anemia.

ObjectiveTo investigate the clinical characteristics of seronegative hepatitis-associated aplastic anemia (AA) (SNHAA) and hepatitis B virus (HBV) infection complicating AA (HBVAA), and thereby compare the efficacy of immunosuppressive therapy (IST).MethodsAn analysis was conducted on the clinical data of ten patients with SNHAA out of 332 cases of AA from our center at AA diagnosis, and on the efficacy of IST. This was compared to 22 cases of HBVAA at AA onset as well as the associated IST outcomes.ResultsNine patients with SNHAA developed severe aplastic anemia, with a median age of 18 years. After IST, six (60%) of the SNHAA patients achieved complete remission and two achieved partial remission. The patients with HBVAA had a total response rate of 82.3%. The disease recurred in two HBVAA patients. No statistically significant differences were observed in response rate, mortality, and recurrence rate between both groups. As compared with HBVAA, patients with SNHAA had a shorter interval from the acute episode of hepatitis to AA onset (4 months versus 92 months, P=0.00), a quicker response to IST (2.5 months versus 4.5 months, P=0.018), a lower proportion of bone marrow hematopoietic tissues (20.6% versus 23.6%, P=0.03), and lower white blood cell and absolute neutrophil count (0.8×109/L versus 1.23×109/L and 0.26×109/L versus 0.58×109/L, P=0.026 and P=0.0009, respectively). No significant liver damage or hepatitis B fulminant infection was observed in either group during the follow-up.ConclusionThe prevalence of SNHAA is 3.01%. SNHAA often presents as severe AA and responds to IST quickly. Neither hepatitis prior to AA nor AA complicating HBV infection have been shown to influence the early efficacy of IST and adverse events, and HBV may not be the causative agent of AA.

Nadir White Blood Cell, Absolute Neutrophil, and Absolute Lymphocyte Counts During Concurrent Chemoradiation Therapy Are Associated With Worse Outcomes in Patients With Limited-Stage Small Cell Lung Cancer

Limited-stage small cell lung carcinoma (LSCLC) has a poor prognosis with a 5-year overall survival of < 20%. Studies have suggested that SCLC may affect the immune system. We hypothesis that baseline or nadir white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), platelet (PLT) count and hemoglobin (Hb) levels during the course of concurrent chemoradiation (CCRT) is associated with treatment outcomes for LSCLC.

Value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age

ObjectiveThe leukocyte count is frequently used to evaluate suspected bacterial infections but estimates of its test performance vary considerably. We evaluated its accuracy for the detection of serious bacterial infections...

Republished: Value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age

ObjectiveThe leukocyte count is frequently used to evaluate suspected bacterial infections but estimates of its test performance vary considerably. We evaluated its accuracy for the detection of serious bacterial infections...

Exploring the Potential Effect of Polypharmacy on the Hematologic Profiles of Clozapine Patients

Clozapine, an atypical antipsychotic with documented efficacy in the management of treatment-resistant schizophrenia, is associated with the risk of adverse hematological outcomes. Of particular concern are reductions in white blood cells (WBC) and absolute neutrophil counts (ANC). Individuals who display moderate leukopenia (3000/mm(3) > WBC ≥ 2000/mm) upon initiation of clozapine therapy are at increased risk of developing agranulocytosis, defined as an ANC less than 500/mm. Complications of agranulocytosis can be severe and include increased risk of infection and mortality. The primary objective of this study was to examine data on clozapine recipients who experienced adverse drug reactions (ADRs) related to decreases in WBC or ANC and ascertain whether other drugs and/or drug interactions had played a role. The analysis included multiple classes of medications. A retrospective chart review was performed of open and closed medical records of all inpatient recipients of clozapine at a state psychiatric center between January 1, 2004 and June 30, 2011. Laboratory records of patients prescribed clozapine were examined for abnormal WBC counts or ANC. A hematological ADR was considered to have occurred if there was a substantial drop in either WBC or ANC or mild or moderate leukopenia or granulocytopenia. Each episode was analyzed for medications that might have contributed to the ADR. Data were collected for all scheduled and STAT medications started at any point during the clozapine patient's hospitalization. The following seven medication groups, based on the Therapeutic Classification System of the American Hospital Formulary System (AHFS), were chosen for analysis because they were consistently used in the majority of the patient population: antihistamines, anti-infectives, autonomic agents, cardiovascular agents, antipsychotics, vitamins, and gastrointestinal agents. Pearson correlation coefficients were calculated to identify associations between the presence of hematological ADRs and medications administered concomitantly with clozapine. The following significant correlation coefficients were found between the use of a class of medications and the occurrence of a hematological ADR: antiinfective agents 0.409 (p < 0.01), gastrointestinal agents 0.329 (p < 0.01), and autonomic agents 0.309 (p < 0.01). In the subset of patients who were prescribed a proton-pump inhibitor or ranitidine concomitantly with clozapine, 24/26 (96%) experienced a hematological ADR. Autonomic agents, anti-infective agents, and proton pump inhibitors and other gastrointestinal agents were all associated with hematological ADRs when co-prescribed with clozapine. Medications from these classes should be initiated cautiously in patients being treated with clozapine to avoid precipitous drops in ANC or WBC that may increase the risk of agranulocytosis.

Management and prevention of agranulocytosis in patients receiving clozapine

Clozapine is an antipsychotic associated with superior efficacy compared to other atypical antipsychotics in the treatment of schizophrenia. However, clozapine use is limited due to its association with a rare but potentially fatal adverse effect, agranulocytosis. Patients receiving clozapine therapy require frequent monitoring of white blood cell (WBC) and absolute neutrophil counts (ANC). This article reviews the monitoring parameters for patients receiving clozapine therapy, and the management and prevention of clozapine-associated agranulocytosis.

White blood cell count is positively associated with benign prostatic hyperplasia

To determine whether low-grade systemic inflammation is associated with prostatic enlargement/benign prostatic hyperplasia. Prostate volume was measured by transrectal ultrasonography in 576 Japanese men. The association between prostate volume and routine clinical inflammatory markers (C-reactive protein level, white blood cell count, or the differential white cell count [neutrophils, lymphocytes, basophils, eosinophils, and monocytes]) were analyzed. Contributors to prostate volume were identified in univariate and multivariable linear regression models. Prostate volume was found to have a positive association with serum prostate-specific antigen level (P < 0.001), white blood cell count (P = 0.027) and absolute neutrophil count (P = 0.010). In univariate linear regression models, a large prostate volume was associated with older age, higher prostate-specific antigen, and higher white blood cell and neutrophil counts. A multivariable model adjusted for age, prostate-specific antigen, and C-reactive protein showed that the white blood cell count and the neutrophil count were independently associated with prostate volume. An increased white blood cell count was also associated with higher total International Prostatic Symptom Scores (P < 0.001). White blood cell count seems to be associated with the degree of prostate enlargement and lower urinary tract symptoms. Chronic low-grade systemic inflammation might be involved in the etiology of benign prostatic hyperplasia.

Blood Neutrophil Counts in HIV-Infected Patients with Pulmonary Tuberculosis: Association with Sputum Mycobacterial Load

BackgroundIncreasing evidence suggests that neutrophils play a role in the host response to Mycobacterium tuberculosis. We determined whether neutrophil counts in peripheral blood are associated with tuberculosis (TB) and with mycobacterial load in sputum in HIV-infected patients.Methodology/Principal FindingsAdults enrolling in an antiretroviral treatment (ART) clinic in a Cape Town township were screened for TB regardless of symptoms. Paired sputum samples were examined using liquid culture, fluorescence microscopy, and the Xpert MTB/RIF assay. Absolute neutrophil counts (ANC) were measured in blood samples. Of 602 HIV-infected patients screened, 523 produced one or more sputum samples and had complete results available for analysis. Among these 523 patients, the median CD4 count was 169×109/L (IQR, 96–232) and median ANC was 2.6×109/L (IQR, 1.9–3.6). Culture-positive pulmonary tuberculosis was diagnosed in 89 patients. Patients with TB had a median ANC of 3.4×109/L (IQR, 2.4–5.1) compared to 2.5×109/L (IQR, 1.8–3.4) among those who were culture negative (p<0.0001). In multivariable analyses, having pulmonary TB was associated with an adjusted risk ratio (aRR) of 2.6 (95%CI, 1.5–4.5) for having an ANC level that exceeded the median value (ANC ≥2.6×109/L; p = 0.0006) and an aRR of 6.8 (95%CI, 2.3–20.4) for having neutrophilia defined by a neutrophil count exceeding the upper limit of the normal range (ANC >7.5×109/L; p = 0.0005). Patients were then classified into four mutually exclusive groups with increasing sputum mycobacterial load as defined by the results of culture, Xpert MTB/RIF and sputum smear microscopy. Multivariable analyses demonstrated that increasing sputum mycobacterial load was positively associated with blood ANC ≥2.6×109/L and with neutrophilia.Conclusions/SignificanceIncreased blood neutrophil counts were independently associated with pulmonary TB and sputum mycobacterial burden in this HIV-infected patient group. This observation supports the growing body of literature regarding the potential role for neutrophils in the host response to TB.

Implementation and impact of pharmacist led medication reconciliation and patient education at discharge from an inpatient behavioral health unit

Transitions of care during a hospitalization, including admission, transfers between units, and discharge are critical processes for medication safety and areas where pharmacy can contribute. Medication discrepancies have a significant impact on patient outcomes and both The Joint Commission (TJC) and the American Society of Health-System Pharmacists (ASHP) have recognized the importance of medication reconciliation in preventing these discrepancies. In 2005, The Joint Commission made medication reconciliation a component of one of its Hospital National Patient Safety Goals (NPSG.08.01.01). Implementation challenges resulted in its suspension in 2009 and 2010 for revision. A modified goal was released in 2011 (NPSG.03.06.01) after a comprehensive review of published literature and available data. Official scoring of the goal started in July 2011.

Predictive factors for plasma cell disorders in African American patients: A community practice perspective.

e19508 Background: African Americans have over two-fold higher incidence of multiple myeloma (MM) compared to other ethnic groups in the United States. Screening tests for MM are most often done when patients present with features suggestive of anemia, renal impairment, hypercalcemia, hypergammaglobulinemia or lytic bone disease, although MM may present with other manifestations. We carried out a retrospective study to investigate the potential clinical variables predictive of plasma cell disorders (PCD) in African American population. Methods: We reviewed the charts of African American patients who had serum protein electrophoresis, immunofixation and serum free light chain levels from 2007 to 2012. We defined traditional triggers for MM workup as hemoglobin (Hb) &lt; 11 g/dL, serum creatinine (Cr) &gt; 1.3 mg/dL, corrected serum calcium (Ca) &gt; 10.5 mg/dL, albumin to globulin ratio (A:G ratio) &lt; 1, and osteopenia or lytic lesion on DEXA scan/X-ray. PCD was defined as monocloncal gammopathy of unknown significance (MGUS), smoldering MM, MM, light chain MGUS or light chain only MM. Results: 254 patients were eligible. Mean and range of age, Cr, Ca, A:G ratio, Hb, total white blood cell, absolute neutrophil and platelet counts were 60 years (21 - 95), 1.05 mg/dL (0.49 - 9.6), 9.5 mg/dL (8.5 - 11), 1.07 (0.31 - 3.08), 11.7 g/dL (5.7 - 16.5), 6 x 103/mm3 (1.9 - 26), 3675 x 103/mm3 (192 - 11765) and 237 x 103/mm3 (22 - 1262), respectively. Twelve (13%) out of 92 patients without traditional trigger variables had PCD. In contrast, 50 (31%) out of 162 patients with trigger variables had PCD (composed of 48% MGUS, 8% smoldering MM, 14% MM, 25% light chain MGUS and 2% light chain only MM). There is a significant association between the presence of trigger variables and PCD (χ2= 9.16, p = .002). The number of trigger variables is positively correlated with the likelihood of a PCD (Spearman’s rho = .22, p &lt; .001). So is increasing age (Spearman’s rho = .29, p &lt; .001) in patients with trigger variables. However, age is not predictive of PCD in patients without trigger variables (rho = .1, p = .34). Conclusions: The number of traditional trigger variables and increasing age (especially over 50 years) are predictive of PCD in African American population.

A Population-Based Study of Bacterial Spectrum in Febrile Neutropenic Patients

Background: Because of great concerns about mortality and morbidity of infection in febrile neutropenic patients, the appropriate empirical antibiotic should be started immediately. Although there are established guidelines for the use of empirical therapy, local microbiological pattern and antibiotic susceptibility should be considered. Objectives: The current study aimed to identify the etiological pathogens in febrile neutropenic cancer patients in Isfahan, Iran. Patients and Methods: This single-centre population-based study was conducted on 81 febrile neutropenic patients referring to Sayed-Al-Shohada hospital, the only referral malignant care center in Isfahan, Iran. Demographic data, duration and kind of malignancy, duration from last chemotherapy, duration of fever, and also physical exam were recorded for each patient. Moreover, procalcitonin, CRP, ESR, white blood cells, hemoglobin, platelet, and absolute neutrophil count were measured. BACTEC and E-test were used for blood culturing and determining the antibiotic susceptibility. Results: Out of 81 participants, 28.4% had positive blood cultures which mostly consisted of Gram-positive microorganisms. In addition, Staphylococcus epidermidis was the most isolated Gram positive bacteria (39.1%). ESR, CRP, and procalcitonin were significantly higher in patients with positive blood culture. The risk of infection increased with raise in duration of hospital stay, catheterization, increased pulse rate, increased oral temperature, low level of oxygen saturation, decreased systolic blood pressure, and low absolute neutrophile count. However, in this case, no relationship was found among the patients’ age, diastolic blood pressure, respiratory rate, duration of diagnosis, duration from last chemotherapy, duration of fever, white blood cells, hemoglobin, platelet, and finally the type of malignancies. Conclusions: It was concluded that Gram-positive bacteria were more prevalent as a cause of infection in the patients with malignancy and the most common pathogen was S. epidermidis. Larger studies are needed to determine the bacterial susceptibility of this center.