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[Empirical antibiotic therapy in febrile neutropenic patients with acute leukemia]
Abstract:
One hundred and ninety-five episodes of fever during the neutropenic phase of chemotherapy in 49 patients with acute leukemia from 1984 to 1987 were analyzed with the following results: 1) Febrile episodes occurred in 80 percent of the neutropenic (less than 500/microliters) phase lasting more than 7 days after chemotherapy. 2) Febrile episodes consisted of 44 (22%) of established septicemia and 111 (57%) of suspected septicemia. 3) The pathogens causing septicemia were 8 GPC, 38 GNB (22 Pseudomonas species) and 6 fungi. Fungemia was confirmed on an average of 4.8 days after the onset of fever. The mortality of septic events was 10 out of 17 episodes (59%) when treated with antibiotics alone, while 8 out 27 (30%) with the combination of antibiotics plus antifungal drugs. 4) The mortality of suspected sepsis was only 2 out of 111 episodes. Eighty-three (75%) of these 111 episodes responded to antibiotics alone, while 26 (23%) cases needed antibiotics plus antifungal drugs. Our results suggest that in febrile neutropenic patient empiric broad-spectrum antibiotic therapy should be initiated which is especially effective for Pseudomonas species, but if fever persists despite more than 4 or 5 days of antibiotic therapy, additional antifungal therapy should be considered.
Insights
Febrile neutropenia in acute leukemia patients often leads to septicemia. Early broad-spectrum antibiotics are crucial, with antifungal therapy recommended if fever persists beyond 4-5 days.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Context:
- Febrile neutropenia is a common and serious complication in acute leukemia patients undergoing chemotherapy.
- The neutropenic phase, characterized by a low white blood cell count (<500/microliters), significantly increases infection risk.
Purpose:
- To analyze the incidence, causative pathogens, and outcomes of febrile neutropenia episodes in acute leukemia patients.
- To evaluate the efficacy of antibiotic and antifungal therapies in managing septicemia during neutropenia.
Summary:
- 195 febrile episodes in 49 acute leukemia patients during neutropenia were analyzed.
- 80% of patients with neutropenia lasting over 7 days experienced fever.
- Septicemia occurred in 22% (established) and 57% (suspected) of febrile episodes, with Gram-negative bacteria (including Pseudomonas) and fungi as key pathogens.
- Mortality was higher with antibiotics alone (59%) versus combined antibiotic-antifungal therapy (30%) for established septicemia.
- Suspected sepsis had low mortality (2/111), with most responding to antibiotics alone.
Impact:
- Findings support initiating empiric broad-spectrum antibiotics for febrile neutropenia, particularly those effective against Pseudomonas species.
- Suggests considering additional antifungal therapy if fever persists for 4-5 days, improving outcomes in high-risk patients.
- Highlights the importance of timely and appropriate antimicrobial strategies to reduce mortality in neutropenic cancer patients.