Incidence and clinical significance of positive blood cultures in febrile episodes of patients with hematological malignancies.
The characteristics of 554 febrile episodes in 126 patients with a hematological malignancy over a 6-year period (1985-90) were reviewed in order to study the current incidence and clinical significance of blood culture positivity. An infection was documented microbiologically in 28% and clinically in 30% of the episodes. Blood cultures were positive in 19% of the febrile episodes. The rate of blood culture positivity was unrelated to the type of hematological malignancy, to neutropenia and to the presence of infection foci. 21% (26/126) of the patients died of sepsis-related causes. Sepsis-related death occurred in 23% of the blood culture positive febrile episodes, with a median survival time of 2 days. Infection prophylaxis did not reduce either the rate of blood culture positivity or the rate of sepsis-related deaths. Thus, the small proportion of febrile episodes whose fever etiology could be established by blood culture represented 'the tip of the iceberg', i.e. rapidly lethal septic infections with a high mortality rate. This fatality could neither be predicted by a search for infection foci nor prevented by infection prophylaxis.
Rintala
E
E
Department of Medicine, Turku University, Finland.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000382:microbiology; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications*; D009190:Myelodysplastic Syndromes / Q000150:complications*; D009503:Neutropenia / Q000150:complications; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications*