title: Secondary infections in cancer patients with febrile neutropenia.
abstract: OBJECTIVE
  Patients with neutropenia due to cancer chemotherapy are prone to severe infections. Cancer patients canexperience >1 infectious episode during the same period of neutropenia. This study aimed to determine the etiologicaland clinical characteristics of secondary infectious episodes in cancer patients with febrile neutropenia and to identifythe factors associated with the risk of secondary infectious episodes.
  
  
  METHODS
  All cancer patients that received antineoplastic chemotherapy at Ankara University, School ofMedicine, Department of Hematology between May 2004 and May 2005 and developed neutropenia were included in thestudy. Data were collected using survey forms that were completed during routine infectious diseases consultation visits.Categorical data were analyzed using the chi-square test, whereas Student's t-test was used for continuous variables.Multivariate logistic regression analysis was performed to identify independent predictors of secondary infections (SIs).
  
  
  RESULTS
  SIs were observed during 138 (53%) of 259 febrile neutropenic episodes. Of the 138 episodes, 89 (64.5%)occurred in male patients with a mean age of 40.9 years (range: 17-76 years). In total, 80% of the SIs were clinically ormicrobiologically documented. Factors on d 4 of the initial febrile episode were analyzed via a logistic regression model. The presence of a central intravenous catheter (OR: 3.01; P<0.001), acute myeloid leukemia (AML) as the underlyingdisease (OR: 2.12; P=0.008), diarrhea (OR: 4.59; P=0.005), and invasive aspergillosis (IA) during the initial febrileepisode (OR: 3.96; P=0.009) were statistically significant risk factors for SIs.
  
  
  CONCLUSIONS
  Among the cancer patients with neutropenia in the present study, AML as the underlying disease, thepresence of a central venous catheter, diarrhea, and IA during the initial febrile episode were risk factors for thedevelopment of SIs.
authors.affiliation: Ankara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Alpay
authors.initials: A
authors.lastname: Azap
authors.affiliation: Ankara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Gülden Yılmaz
authors.initials: GY
authors.lastname: Bozkurt
authors.affiliation: Medicana International Ankara Hospital, Ankara, Turkey.
authors.forename: Meltem Kurt
authors.initials: MK
authors.lastname: Yüksel
authors.affiliation: Ankara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Kutlu
authors.affiliation: Ankara University, School of Medicine, Department of Hematology, Ankara, Turkey.
authors.forename: Pervin
authors.initials: P
authors.lastname: Topçuoğlu
authors.affiliation: Ankara Numune Education and Research Hospital, Department of First Infectious Diseases and Clinical Microbiology, Ankara Turkey.
authors.forename: Adalet
authors.initials: A
authors.lastname: Aypak
authors.affiliation: Ankara University, School of Medicine, Department of Hematology, Ankara, Turkey.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Akan
keywords: Febrile neutropenia; Hematologic malignancy; Secondary infection
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