Clinical Aspects and Prognostic Factors of Neutropenic Fever in Leukemic Patients: 1996~2001

Rho, Young Hee; Lee, Yeon Joo; Lee, Jacob; Eom, Joong Shik; Sohn, Jang Wook; Choi, Chul Won; Cheoung, Hee Jin; Kim, Woo Joo; Kim, Min Ja; Kim, Jun Suk; Park, Seung Chull

Abstract

BACKGROUND: Cancer therapy-related infections due to neutropenia is a well known problem in cancer treatment. Leukemia increases the risk furthermore because of its nature of bone marrow involvement. Therefore knowledge of the aspects of infections in neutropenic leukemic patients are important in preventing morbidity and mortality.
METHODS
This study was conducted by reviewing clinical records of 69 cases of 49 leukemic patients who had neutropenic fever during 1996~2001. Each case was reviewed and analyzed in terms of clinical status & treatment, laboratory results, origins of fever and pathogens (if origin was infectious), final outcome and prognostic factors.
RESULTS
Of 69 cases of 49 leukemic patients with neutropenic fever, mortalilty was 29%. Microbiologically defined infection (MDI) was 45% and clinically defined infection (CDI) was 30.4%, which meant a increase in MDIs compared with the previous study. Major focuses of fever were lung, blood and catheter-related, which were similar to those of 1988~1995. The major pathogens were gram negative bacilli (43.2%), followed by gram positive cocci (29.7%), but the proportion of gram positive pathogens had increased. Age, usage of selective gut decontamination and colony-stimulating factors (CSFs), and the presence of bone marrow recovery were related to prognosis by univariate analysis. Multivariate logistic regression analysis revealed that the bone marrow recovery was the only significantly related to patient's outcome, which was the same as the previous study (P<0.001).
CONCLUSION
Proportions of pathogens in febrile neutropenic patients were similar with the previous study, but gram positive infections are increasing recently. Bone marrow recovery was the only significant prognostic factor in these patients. And, the benefits of selective gut decontamination or CSF usage is still questionable.