Fever, neutropenia and malignancy: a clinical syndrome in evolution

During a 12-month period, 43 consecutive episodes of new fever in neutropenic cancer patients were evaluated. A two-drug combination of cephalothin, gentamicin or carbenicillin was used empirically for each episode. Overall mortality for this series was 28%. Microbiologic documentation of infection occurred in only nine of 43 episodes but a probable site of infection was observed in 14 others. The lungs were the most common site of infection and pneumonia was associated with a 100% fatal outcome. Despite the large number of febrile episodes with no infectious isolates, response to empiric broad-spectrum antibiotics was common (n = 23) and was associated with 4% mortality compared to 55% mortality in episodes with no response. Superinfection occurred only in patients treated with antibiotics longer than 7 days (4 of 30). Bone marrow recovery was associated with lower mortality but was not essential for survival. The routine use of empiric broad-spectrum antibiotics for all unexplained febrile episodes in neutropenic cancer patients has led to an increased frequency of culture-negative episodes. Care must be taken to avoid over-use of these empiric drugs.