Neutropenic sepsis complicating treatment of solid tumours, lymphoma and myeloma.
Ninety-three episodes of fever or infection while neutropenic (defined as neutrophil count < 2.0 x 10(9)/l) occurred in 76 patients treated for solid tumours, lymphoma and myeloma over a 4-year period. Most followed the first (39%) or second (18%) cycle of chemotherapy. The neutrophil count at onset of sepsis was < 0.5 x 10(9)/l in 69%. Pathogens were isolated in 32 episodes (34%) and a clinical focus detected in a further 19 (20%). Gram negative bacteria accounted for 51% of pathogens; 49% of bacteria were isolated from blood, 65% of them were Gram negative. The initial antibiotic regimen was cefuroxime with gentamicin or tobramycin in 76 episodes. Fever or infection resolved on first line antibiotics in 78%. The mean duration of antibiotic therapy was 7.6 days. Antibiotic therapy was changed following urine culture in 1.5% of 66 episodes and following chest radiography in 5.8% of 69 episodes, where these tests were performed. Nine (9.6%) patients died from infection, all of whom were receiving second line salvage chemotherapy. Three other patients died of progressive malignancy with sepsis present. In six major diagnostic groups, 56 episodes of infection or fever complicated 4% of chemotherapy cycles.
Wilkinson
T J
TJ
Oncology Service, Canterbury Area Health Board, Christchurch, New Zealand.
Robinson
B A
BA
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D002444:Cefuroxime / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005436:Floxacillin / Q000627:therapeutic use; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced*; D011446:Prospective Studies; D016879:Salvage Therapy; D014031:Tobramycin / Q000627:therapeutic use
D005839:Gentamicins; D005436:Floxacillin; D002444:Cefuroxime; D014031:Tobramycin