Infectious events after endoscopic procedures in patients with neutropenia and hematologic diseases

Few studies evaluated the post-endoscopic adverse events in patients with neutropenia. We investigated the development of infectious events after endoscopic procedures in neutropenic patients with hematologic diseases.

Patients with neutropenia and hematologic diseases who underwent endoscopic procedures were enrolled. Neutropenia was defined as an absolute neutrophil count < 1500 cells/mm³ and its severity was subdivided as mild, moderate (< 1000 cells/mm³), and severe (< 500 cells/mm³). Infectious events were defined as fever or bacteremia within 7 days after endoscopy. We assessed the development and risk factors of infectious events after endoscopic procedures.

We identified 528 procedures in 479 patients (51.0 ± 1.0 years). Antibiotics were used in 455 (95.0%) cases within 3 days of endoscopy. Infectious events were observed in 154 patients (32.2%): 22.9% in mild, 29.5% in moderate, and 43.1% in severe neutropenia. Fever developed in 147 cases (30.7%). Among patients with blood culture studies (n = 267), bacteremia was found in 22 cases (8.2%). In univariate analysis, patients with myelodysplastic syndrome, poor performance status, severe neutropenia, non-use of immunosuppressive drugs, and without history of hematopoietic stem cell transplantation and colony-stimulating factor use were positively correlated with infectious events. Poor performance status was the strongest factor for the development of infectious events in multivariate analysis (OR 10.3; 95% CI 4.4-23.3; P < 0.01).

Procedural invasiveness and severity of neutropenia did not appear to affect infectious events after endoscopic procedure with the use of antibiotics. Neutropenic patients who have poor performance status require careful evaluation for appropriate indications of endoscopic evaluation.