A European Organization for Research and Treatment of Cancer-International Antimicrobial Therapy Group Study of secondary infections in febrile, neutropenic patients with cancer.
BACKGROUND
Neutropenic patients with cancer may develop several episodes of fever and infection during chemotherapy-induced myeloaplasia.


METHODS
To identify risk factors for secondary infectious episodes among patients who responded to initial antibiotic therapy, we retrospectively analyzed 2 consecutive, prospective, randomized clinical trials performed by the International Antimicrobial Therapy Group of the European Organization for Research and Treatment of Cancer during 1991-1994.


RESULTS
Of 1720 patients with their first episode of febrile neutropenia, 836 responded to the initial antibiotic regimen and were therefore suitable for our analysis. A secondary infection was observed in 129 (15%) of 836 patients that occurred at a median of 10 days (range, 1-28 days) after the onset of the primary febrile episode. Factors at both baseline and day 4 were analyzed. Age of >16 years (odds ratio [OR], 3.46; P<.001), acute leukemia in first induction (OR, 3.17; P<.001), presence of intravenous line (OR, 1.88; P=.04), severe neutropenia (defined as an absolute granulocyte count of <100 cells/mm(3)) on day 4 (OR, 2.72; P<.001), and type of documentation of the primary episode (i.e., microbiologically documented cause or unexplained fever; OR, 2.56; P=.001) were found to be risk factors for secondary infection. The risk of death was higher among patients who developed a secondary infectious episode than among those who did not (5.4% vs. 1.4%; P<.01).


CONCLUSIONS
The clinical parameters described above may help to identify neutropenic patients at risk of developing secondary infection.
Akova
Murat
M
Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey. makova@hacettepe.edu.tr
Paesmans
Marianne
M
Calandra
Thierry
T
Viscoli
Claudio
C
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D005060:Europe; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors
D000900:Anti-Bacterial Agents