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[Infection in elderly leukemic patients]
M Kikukawa1, Y Ishida, K Kuramoto
1Department of Hematology Tokyo Metropolitan Geriatric Hospital.
Abstract:
Febrile episodes occurring in 29 elderly patients (mean age 75 years) with leukemia, from 1988 to 1993, were reviewed. A febrile episode was defined as a temperature of 38 degrees C or greater for at least 6 hours. The number of febrile episodes was 64. The average was 2.2 febrile episodes per patient. Seventy-two percent of febrile episodes occurred when the patients had neutropenia below 100/microliters, while 16% occurred with neutropenia of 101/microliters to 500/microliters. Causative microorganisms were identified in 48% of total febrile episodes. The most common infectious site was the urinary tract which accounted for 25% of total episodes. Pneumonia and septicemia accounted for 22% of total episodes, respectively. Gram-positive cocci were responsible for 66% of microbiologically documented febrile episodes, while 21% were caused by gram-negative bacilli. Gram-positive cocci, particularly staphylococcus aureus, coagulae-negative staphylococcus and enterococci increased compared with a decade ago in our department. Granulocyte colony-stimulating factor (G-CSF) was used 12 times for infection. No significant difference in fever amelioration was seen between G-CSF and non-G-CFS cases.
Insights
Elderly leukemia patients experienced frequent febrile episodes, often linked to neutropenia. Gram-positive cocci infections increased, with no significant benefit from granulocyte colony-stimulating factor (G-CSF) for fever reduction.
Area of Science:
- Hematology
- Infectious Diseases
- Geriatrics
Background:
- Febrile episodes are common in elderly leukemia patients.
- Neutropenia significantly increases the risk of fever in these patients.
Purpose of the Study:
- To review febrile episodes in elderly leukemia patients.
- To identify causative microorganisms and infectious sites.
- To evaluate the efficacy of granulocyte colony-stimulating factor (G-CSF).
Main Methods:
- Retrospective review of 29 elderly leukemia patients (mean age 75) from 1988-1993.
- Analysis of 64 febrile episodes (temperature >= 38°C for >= 6 hours).
- Correlation of febrile episodes with neutropenia levels and identification of causative pathogens.
Main Results:
- Average of 2.2 febrile episodes per patient; 72% occurred with neutropenia < 100/microliter.
- Urinary tract infections (25%), pneumonia (22%), and septicemia (22%) were most common.
- Gram-positive cocci (66%) predominated, showing an increase, particularly Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococci.
- G-CSF use showed no significant difference in fever amelioration compared to non-G-CSF cases.
Conclusions:
- Elderly leukemia patients are prone to recurrent febrile episodes, strongly associated with neutropenia.
- There is a concerning rise in Gram-positive cocci infections in this patient group.
- Granulocyte colony-stimulating factor (G-CSF) did not demonstrate a significant benefit in reducing fever duration or severity in this study population.