title: Management of febrile neutropenia in solid organ malignancies following chemotherapy.
abstract: BACKGROUND
  Febrile neutropenia is a medical emergency and it requires immediate hospitalization for evaluation and administration of empiric broad-spectrum antibiotics. The present study was undertaken to analyze the infectious agents, choice of empiric antibiotics, and outcome in high-risk febrile neutropenia in the solid organ malignancies.
  
  
  METHODS
  In this study, 92 high risk febrile neutropenic episodes were analyzed in 72 patients with solid organ malignancies. We used cefoperazone-sulbactum as an initial empiric antibiotic. Piperacillin/tazobactum or carbapenems were added to the patients who did not respond to initial antibiotic.
  
  
  RESULTS
  Among the 92 episodes treated, most patients received first-line chemotherapy for locally advanced disease. Microbes were isolated in 25% of febrile neutropenic episodes. Gram-negative organism (61.70%) constituted the most common isolates. The most common microbes identified were E. coli and Staphylococcus aureus in blood, Klebsiella pneumonia in sputum and E. coli in urine culture. Patients who had been treated with cefoperazone-sulbactum improved clinically in 70.6% of febrile neutropenic episodes. Second- line antibiotics (piperacillin-tazobactum with amikacin) were required in 24% episodes, while another 5.4% episodes required third-line antibiotics (carbapenems). In this study, mortality was seen in 12% of febrile neutropenic episodes. Staphylococcus aureus was 100% sensitive to linezolid, teicoplanin, and vancomycin, whereas Gram-negative organisms were 100% sensitive to imepenem and meropenem.
  
  
  CONCLUSIONS
  Cephaperazone-sulbactum is a reasonable initial choice for empirical therapy in high risk febrile neutropenic patients in solid organ malignancies.
authors.forename: Kuntegowdanahalli C
authors.initials: KC
authors.lastname: Lakshmaiah
authors.affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
authors.forename: S M
authors.initials: SM
authors.lastname: Abhayakumar
authors.forename: Rachan
authors.initials: R
authors.lastname: Shetty
authors.forename: D
authors.initials: D
authors.lastname: Loknath
authors.forename: R S
authors.initials: RS
authors.lastname: Jayashree
authors.forename: K
authors.initials: K
authors.lastname: Govindbabu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D019468:Disease Management; D064147:Febrile Neutropenia / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents