[Management of 315neutropenic febrile episodes in a cancer center].
Management of febrile neutropenic patients is described in guidelines. Each cancer center can adapt these according to its local bacterial ecology. We present a retrospective study made in a cancer center from 2001 to 2003.


METHODS
Three hundred and fifteen febrile neutropenic episodes after chemotherapy (66% for solid tumor) were analysed.


RESULTS
For 279 episodes, no antibiotic therapy was given before admission. Clinical or radiological manifestations occurred in 46%; microbiologically documented infections by hemocultures in 28% (Gram positive: 42%; Gram negative: 51%) and by puncture in 14% (Gram negative: 58%). The length of pyrexia was inferior to 7 days in 88% and neutropenia inferior 7 days in 80.8%. 79.7% of episodes were treated with one of the three antibiotic therapy recommended by the center (ceftriaxone+tobramycin; ceftriaxone+ciprofloxacin; ceftriaxone+ofloxacin); 13.3% were treated with an other therapy; 7% received no antibiotic therapy. 68.5% of patients treated with one of the three antibiotic therapies, became afebrile without changing the antibiotic protocol.


CONCLUSIONS
In our study, there were a majority of Gram negative bacteria except for Pseudomonas aeruginosa. The three antibiotic therapy recommended by the center (third generation cephalosporin+aminoglycosides or fluoroquinolones) were effective and glycopeptide was not necessary in first intention treatment.
Dutronc
H
H
Fédération de maladies infectieuses et tropicales, hôpital Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. herve.dutronc@chu-bordeaux.fr
Billhot
M
M
Dupon
M
M
Eghbali
H
H
Donamaria
C
C
Dauchy
F-A
FA
Reiffers
J
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents