title: Bacterial infection profiles in lung cancer patients with febrile neutropenia.
abstract: BACKGROUND
  The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.
  
  
  METHODS
  We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm(3)) and fever (temperature > 38.3°C).
  
  
  RESULTS
  The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. Staphylococcus species (mainly S. aureus) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm(3).
  
  
  CONCLUSIONS
  Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.
authors.affiliation: Department of Infectious Diseases, Amiens University Medical Center, France. lanoix.jean-philippe@chu-amiens.fr
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lanoix
authors.forename: Emilie
authors.initials: E
authors.lastname: Pluquet
authors.forename: Francois Xavier
authors.initials: FX
authors.lastname: Lescure
authors.forename: Houcine
authors.initials: H
authors.lastname: Bentayeb
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Lecuyer
authors.forename: Marie
authors.initials: M
authors.lastname: Boutemy
authors.forename: Patrick
authors.initials: P
authors.lastname: Dumont
authors.forename: Vincent
authors.initials: V
authors.lastname: Jounieaux
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Schmit
authors.forename: Charles
authors.initials: C
authors.lastname: Dayen
authors.forename: Youcef
authors.initials: Y
authors.lastname: Douadi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000097:blood / Q000150:complications* / Q000382:microbiology; D005260:Female; D005334:Fever / Q000097:blood / Q000150:complications* / Q000382:microbiology; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000209:etiology* / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017211:Treatment Failure