Usefulness of bacteriologic cultures in choice of antibiotics in patients with chemotherapy-induced neutropenic sepsis.
Neutropenic sepsis is a potential problem in cancer patients undergoing cytotoxic chemotherapy. Septic work-up including cultures from various sites is routinely done for these patients. To assess the usefulness of these cultures, a retrospective review of all patients admitted for neutropenic sepsis in the period from June 1994 to August 1995 was conducted. All patients included in the study had solid tumours which were being treated at our institution during the study period. All had fever and documented neutrophil count of < 1 x 10(9)/l on at least one occasion. There was a total of 41 patients with 52 episodes of neutropenic sepsis. Of the 52 episodes, there were positive cultures in 14 (27%) episodes, including 7 from blood, 2 from urine and 5 from skin. In the bacteriologic cultures, gram-negative bacteria were isolated in 11 episodes and gram-positive bacteria in 5 episodes (2 episodes had both gram-negative and gram-positive bacteria isolated, and 1 episode had two gram-negative bacteria). Majority of the patients (96%) were treated with a third generation cephalosporin with/without an aminoglycoside. This empirical treatment was effective with resolution of fever in 39 (75%). Thirteen (25%) had change of antibiotics because of deteriorating clinical state or drug resistance. Nine patients with unabated sepsis had bacteriological cultures which grew organisms resistant to the empirical antibiotics. Eight responded to the change of antibiotics. One patient with pseudomonas bacteraemia failed to respond to empirical treatment with ceftriaxone and died before antibiotics could be changed. Of the patients with positive cultures, the results of drug sensitivity made a difference to treatment. None of the patients with negative cultures died from sepsis. It appears that even though the rate of positive culture is low (27%), it is still useful as a guide when change of antibiotics is required.
Leong
S S
SS
Department of Medical Oncology, Singapore General Hospital, Singapore.
Ang
P T
PT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001419:Bacteria / Q000145:classification / Q000187:drug effects; D001424:Bacterial Infections / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology*; D013045:Species Specificity
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents