Invasive fungal infections in neutropenic enterocolitis: a systematic analysis of pathogens, incidence, treatment and mortality in adult patients.
BACKGROUND
Neutropenic enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal neutropenic enterocolitis.


METHODS
Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal neutropenic enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal neutropenic enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature.


RESULTS
Among 186 articles describing patients with neutropenic enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal neutropenic enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy.


CONCLUSIONS
In patients with neutropenic enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in neutropenic enterocolitis.
Gorschlüter
Marcus
M
Department of Internal Medicine I, University of Bonn, Germany. gorschlueter@uni-bonn.de
Mey
Ulrich
U
Strehl
John
J
Schmitz
Volker
V
Rabe
Christian
C
Pauls
Katharina
K
Ziske
Carsten
C
Schmidt-Wolf
Ingo G H
IG
Glasmacher
Axel
A
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D044504:Enterocolitis, Neutropenic / Q000150:complications*; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D009181:Mycoses / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
D000935:Antifungal Agents