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[Infection in severe neutropenia: analysis of 140 episodes]
Abstract:
We analyzed infections complicating 140 episodes of severe neutropenia in 86 patients. The underlying diagnosis was acute leukemia in 64, lymphoma in 12 and isolated cases of bone marrow aplasia, agranulocytosis, dysmyelopoiesis and solid tumors. No fever developed in 35 (25%) episodes. No cause for the fever was identified in 40% of the remaining episodes. Clinical evidence of an infection was present in 20%, with positive bacteriologic findings in 27%. Respiratory infection (16%), pneumonia (11%) and sepsis (10%) were the most common infectious processes. Infectious agents isolated were gram negative bacilli (72%), gram positive cocci (19%) and fungi (9%). The association of amikacin and carbenicillin or cephalosporins proved to be superior to gentamycin-penicillin (p less than 0.01). 16 patients died for an overall mortality of 11%. Pneumonia and infection by K pneumoniae or C albicans were associated to a poorer prognosis.
Insights
Severe neutropenia patients experienced significant infections, with gram-negative bacilli being most common. Combination antibiotic therapy improved outcomes, though pneumonia and specific infections indicated a poorer prognosis.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Context:
- Severe neutropenia, often resulting from treatments for acute leukemia and lymphoma, significantly increases infection risk.
- Infections are a major complication in patients with hematologic malignancies and other conditions causing neutropenia.
- Understanding infection patterns and effective treatments is crucial for improving patient survival.
Purpose:
- To analyze the spectrum of infections in patients with severe neutropenia.
- To evaluate the efficacy of different antibiotic regimens in treating these infections.
- To identify factors associated with mortality in neutropenic patients.
Summary:
- This study reviewed 140 episodes of severe neutropenia in 86 patients, primarily those with acute leukemia or lymphoma.
- Infections were diagnosed in a significant proportion, with respiratory infections, pneumonia, and sepsis being most frequent. Gram-negative bacilli predominated among isolated pathogens.
- A combination of amikacin with carbenicillin or cephalosporins demonstrated superior efficacy compared to gentamycin-penicillin (p < 0.01). Overall mortality was 11%, with pneumonia and infections by K. pneumoniae or C. albicans linked to worse outcomes.
Impact:
- The findings highlight the critical role of prompt and effective antibiotic therapy in managing infections in severe neutropenia.
- Identifying specific pathogens and risk factors aids in optimizing treatment strategies and improving patient prognoses.
- This research contributes to evidence-based guidelines for infection control and treatment in immunocompromised patient populations.