title: Survival in neutropenic patients with severe sepsis or septic shock.
abstract: OBJECTIVE
  To determine whether the survival gains achieved in critically ill cancer patients in recent years exist in the subset with neutropenia and severe sepsis or septic shock.
  
  
  METHODS
  Retrospective 11-yr study (1998-2008).
  
  
  METHODS
  Medical intensive care unit in a teaching hospital.
  
  
  METHODS
  Four hundred twenty-eight intensive care unit patients with cancer, neutropenia, and severe sepsis or septic shock. The primary outcome was hospital mortality.
  
  
  RESULTS
  The main underlying diseases were acute leukemia (35.7%), lymphoma (31.7%), and solid tumors (16.5%). Two hundred thirty-seven (55.5%) patients had microbiologically documented infections, 141 (32.9%) clinically documented infections, and 50 (11.9%) fever of unknown origin. Acute noninfectious conditions were diagnosed in 175 of 428 (41%) patients, including 26 of 50 (52%) patients with fever of unknown origin, 66 of 141 (47%) patients with clinically documented infections, and 83 of 237 (35%) patients with microbiologically documented infections. Early indwelling catheter removal was performed routinely in the 107 (25%) patients without clinical evidence of a septic focus at intensive care unit admission. Early beta-lactam plus aminoglycoside therapy was used in 391 (91.3%) patients. Hospital mortality was 49.8%. Hospital mortality decreased from 58.7% (108 of 184) in 1998-2003 to 43% in 2004-2008 (105 of 244, p = .006). Multivariate analysis identified nine independent predictors of hospital mortality, of which six were associated with higher mortality (older age; need for vasopressors; neurologic, respiratory, or hepatic dysfunction; and acute noninfectious condition) and three with lower mortality (intensive care unit admission after 2003, combination antibiotic therapy including an aminoglycoside, and early indwelling catheter removal).
  
  
  CONCLUSIONS
  In neutropenic patients with severe sepsis or septic shock, survival improved over time. Aminoglycoside use and early catheter removal in patients with undocumented sepsis may improve survival. Acute noninfectious conditions are associated with increased mortality, underlining the need for thorough and repeated clinical assessments.
authors.affiliation: Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Assistance Publique - Hopitaux de Paris, and University of Paris, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
authors.forename: Adeline
authors.initials: A
authors.lastname: Max
authors.forename: Vincent
authors.initials: V
authors.lastname: Peigne
authors.forename: Eric
authors.initials: E
authors.lastname: Mariotte
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.forename: Alexandre
authors.initials: A
authors.lastname: Debrumetz
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.forename: Amélie
authors.initials: A
authors.lastname: Seguin
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000367:Age Factors; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009503:Neutropenia / Q000150:complications / Q000276:immunology / Q000401:mortality*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000276:immunology / Q000401:mortality*; D012772:Shock, Septic / Q000150:complications / Q000276:immunology / Q000401:mortality*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents