[Bacterial septicemia in neutropenia patients]

Two hundred bacterial septicemia occurring in neutropenic patients (PMN less than 1,000 microliter) were analyzed. Most of these patients had hematologic malignancies. The underlying disease, the degree of neutropenia the association of septic focus with the bacteremia, the responsive microorganisms and their evolution during hospitalization were studied as prognosis factors. The overall mortality was 32.5 p. 100. The mortality was higher in patients whose granulocyte count was lower than 500 microliter. The occurrence of major septic focus (pulmonary, perineal infection, diarrhea with abdominal distension, ORL, or cutaneous extensive focus) during bacteremia was a highly significant factor of bad prognosis. The mortality of bacteremias with and without major septic focus was respectively 62 p. 100 and 15 p. 100. A study of the distribution of the bacterias was performed in terms of mortality and duration of hospitalization. "Escherichia coli" and gram positive cocci were predominant during the two first days and mortality was then low. After that time, others Gram-negative bacterias appeared, especially "Pseudomonas aeruginosa" and the mortality was increasing until the twentieth day. Therefore, the authors raise the opportunity of antibiotic therapy according to the duration between the beginning of the hospitalization and the occurrence of sepsis in neutropenic patients. The role of the extensive use of a curative antibiotic association using colistine and nalidixic acid between 1974 and 1976 is discussed in the emergence of more gram positive cocci bacteremias between 1976 and 1978 than between 1974 and 1976 in the same intensive care unit.