Evolution of the clinical manifestations of infection during the course of febrile neutropenia in patients with malignancy.
The impact of a standardized set of diagnostic interventions on the further management of 968 episodes of fever in neutropenic cancer patients who did not respond to initial therapy was assessed prospectively. At the onset of fever, 65% of patients had no additional signs of infection, whereas skin and soft tissue infections were present in 12%, and clinical sepsis and gastrointestinal infections in 8% each. After 72 h, 41% of the fevers still remained unexplained. New foci of infection emerged in 11% of the cases involving mainly the lungs, skin and soft tissues, and urinary tract. The presence of a lower respiratory tract infection or a microbiologically defined infection of any sort was associated with higher mortality than other types of infection were. Changes in initial antibiotic therapy were based on the results of the diagnostic measures specified in the protocol in only 15% of the cases.
Dompeling
E C
EC
Div. of Hematology, University Hospital St. Radboud, Nijmegen, The Netherlands.
Donnelly
J P
JP
Raemaekers
J M
JM
Deresinski
S C
SC
Feld
R
R
De Pauw
B E
BE
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D002442:Ceftazidime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy / Q000209:etiology*; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D010406:Penicillins / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D011446:Prospective Studies; D014031:Tobramycin / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D002442:Ceftazidime; D014031:Tobramycin; D010878:Piperacillin