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Characteristics and Management of Patients With Febrile Neutropenia

David Bai, PharmD
Seeking to determine how FN is managed in most referral hospitals in Iran, researchers studied patients hospitalized during a 6-month period, also taking into account characteristics of FN patients and the risk factors associated with FN development.
Patients with cancer are at risk of developing febrile neutropenia (FN), one of the most serious disease complications associated with chemotherapy. Seeking to determine how FN is managed in most referral hospitals in Iran, researchers studied patients hospitalized during a 6-month period, also taking into account characteristics of FN patients and the risk factors associated with FN development.

Between April and September 2016, adults were admitted to the hospital for FN diagnosis or were diagnosed with FN after receiving chemotherapy at the hospital. Fever was defined as a single oral temperature of >38.3°C (101°F) or a temperature of >38.0°C (100.4°F) for >1 hour, while neutropenia was defined as an absolute neutrophil count (ANC) < 500 cells/μL or an ANC expected to decrease to < 500 cells/μL within the next 48 hours. Patients were classified as low-risk or high-risk according to neutropenia duration (greater or less than 7 days), hepatic or renal dysfunction, and ANC count.

Throughout the study period, 115 patients with cancer were admitted with or encountered FN during the hospital stay, resulting in an incidence rate of 1.26%. The mean hospital stay was 8.5 days (2-33 days) and the major cancer types were hematological cancers. Most patients admitted were classified as low risk (72.2% vs 27.8% for high risk). The median duration of neutropenia was 4 days, while the median duration of a fever was 1 day.

Upon examination, 31.17% of the patients had an infection with a specific focal point. The rest of the patients did not have a defined focal infection. Eighty-seven percent of patients were treated with empiric antibiotics within 60 minutes. Two of the most commonly prescribed antibiotics given in the emergency room were meropenem (91.3%) and vancomycin in combination with meropenem (47.82%). In accordance with IDSA guidelines, 95% of the doses for the prescribed antibiotics were in accordance with the guidelines. However, only 27.8% of patients had indication for vancomycin empiric therapy.

Antimicrobial susceptibility testing was done in 61% of patients. Of these blood cultures, only 17.4% were positive. Of the positive cultures, gram-positive microorganisms were more prevalent, with Staphylococcus epidermidis and Staphylococcus aureus as the 2 most commonly identified bacteria (30% vs 15%, respectively). Aside from microbiological evaluations, 70% of patients also went through plain radiographs, magnetic resonance imaging, or computed tomography.

From this study, the management of FN mainly was in accordance with guidelines. The characteristics of patients with FN were also examined, with patients classified as high risk, and most of the infections being gram-positive. Furthermore, female gender and lymphopenia were identified as predictors for FN. More information should be reviewed in the future on proper antibiotic use and antibiotic de-escalation, according to the investigators.

Reference:

Karimi F, Ashrafi F, Moghaddas A, Derakhshandeh A. Management of febrile neutropenia: a description of clinical and microbiological findings by focusing on risk factors and pitfalls. J Res Pharm Pract. 2018;7(3):147-156. doi: 10.4103/jrpp.JRPP_18_16.

 
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