Factors predicting outcome in high risk febrile neutropenia in patients receiving intensive chemotherapy for acute sleukemia: A prospective, observational study from South India.
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Date
2014-10
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Abstract
BACKGROUND: Outcome of febrile neutropenia (FN) in acute leukemia patients undergoing intensive chemotherapy from India is scanty.
MATERIALS AND METHODS: A prospective, observational, single institutional study was conducted to evaluate the clinical features, microbiological
aspects, risk factors influencing the outcome of high risk FN during intensive therapy in acute leukemia. RESULTS: Among 115 febrile episodes,
though 94 (81.7%) had indwelling central venous catheter (CVC) at the time of diagnosis of FN, infective foci clinically were identified in 70.4% of
episodes, with lung as the major site (25.2%) followed by CVC (17.4%). Microbiological documentation was possible in 33% (n = 40) episodes.
Gram‑negative bacteria isolates were 58.3% and Gram‑positive isolates were 41.7% of which Pseudomonas was the predominant Gram‑negative
and Staphylococcus aureus was the most common Gram‑positive isolate. Piperacillin‑tazobactam + amikacin were used as first line antibiotic in
93% episodes and second line antibiotics were necessary in 73% episodes. Granulocyte colony stimulating factor was used in 60.9% episodes of
high risk FN mostly in acute myeloid leukemia consolidation patients. Eighteen episodes (15.7%) were assigned to have invasive fungal disease.
Eleven (9.6%) out of 115 high risk FN had a fatal outcome. Presence of pulmonary infection predicted for fatal outcome (P = 0.02). CONCLUSION: This
study reports the outcome of high risk FN in patients with acute leukemia undergoing intensive chemotherapy. Gram‑negative isolates are highly
sensitive to piperacillin‑tazobactum and hence in a cost restraint scenario, carbapenems needs to be judiciously used. Focus of Infection in lungs
during FN predicted higher fatal outcomes.
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Keywords
Acute leukemia, catheter related infections, febrile neutropenia, high risk
Citation
Rajendranath R, Balasubramaniyum V K K, Vijayakumar V, Ganesan P, Tenali G S. Factors predicting outcome in high risk febrile neutropenia in patients receiving intensive chemotherapy for acute sleukemia: A prospective, observational study from South India. Indian Journal of Cancer. 2014 Oct-Dec; 51(4): 481-486.