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Related Experiment Videos

Differences between first and subsequent fevers during prolonged neutropenia.

J R Wingard, G W Santos, R Saral

    Cancer
    |February 15, 1987
    PubMed
    Summary
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    Fever during neutropenia in bone marrow transplant patients often requires antimicrobial therapy changes. Subsequent fevers are less likely to be localized infections and may involve gentamicin-resistant Gram-negative pathogens.

    Area of Science:

    • Hematology
    • Infectious Diseases
    • Transplantation Medicine

    Background:

    • Fever is a common complication in patients undergoing allogeneic bone marrow transplantation (BMT).
    • Neutropenia, a state of low white blood cell count, increases the risk of infection.
    • Understanding fever patterns and causes is crucial for effective patient management post-BMT.

    Purpose of the Study:

    • To analyze febrile episodes in neutropenic patients before engraftment following allogeneic BMT.
    • To compare characteristics of first febrile episodes versus subsequent fevers.
    • To identify differences in infection types, pathogens, and antibiotic resistance patterns.

    Main Methods:

    • Retrospective analysis of 86 consecutively treated patients undergoing allogeneic BMT.

    Related Experiment Videos

  • Detailed review of 132 febrile episodes occurring during neutropenia.
  • Comparison of first (n=79) versus subsequent (n=42) fevers, analyzing presumed localized infection (PLI) and sepsis.

    • Main Results:

    • Most patients (84/86) experienced febrile episodes requiring antimicrobial therapy modification.
    • Subsequent fevers were significantly less likely to be identified as PLI (28% vs 75%) compared to first fevers.
    • Gram-negative pathogens in sepsis during subsequent fevers showed increased gentamicin resistance (P=0.01).

    Conclusions:

    • Fever management in neutropenic BMT patients frequently necessitates antimicrobial therapy adjustments.
    • Oropharyngeal mucosal disease was a common cause of first fevers, but less so for subsequent fevers.
    • Shifting patterns of infection and increasing antibiotic resistance in subsequent fevers highlight the need for vigilant monitoring and tailored antimicrobial strategies.