title: Bacteremia in adult cancer patients with apparently stable febrile neutropenia: data from a cohort of 692 consecutive episodes from a single institution.
abstract: BACKGROUND
  Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.
  
  
  OBJECTIVE
  To assess the risk factors and the impact of bacteremia in ASPs.
  
  
  METHODS
  We retrospectively analyzed 861 consecutive episodes of FN that were classifed according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.
  
  
  RESULTS
  We classifed 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specifcity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.
  
  
  CONCLUSIONS
  A single-center, retrospective analysis, and the absence of a validation set to test the model's discriminatory ability.
  
  
  CONCLUSIONS
  Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identifed several variables that could improve the prognostic classifcation of clinically stable FN.
authors.affiliation: Departments of Hematology and Medical Oncology, Hospital Morales Meseguer, Murcia, Spain. alberto.carmonabayonas@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.forename: Paula Jiménez
authors.initials: PJ
authors.lastname: Fonseca
authors.forename: Carme
authors.initials: C
authors.lastname: Font
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Martínez-García
authors.forename: Francisco
authors.initials: F
authors.lastname: Torrella
authors.forename: Edgar
authors.initials: E
authors.lastname: Urrego
authors.forename: Patricia
authors.initials: P
authors.lastname: Castaño
authors.forename: Agustín
authors.initials: A
authors.lastname: Navarrete
authors.forename: Maite
authors.initials: M
authors.lastname: Antonio-Rebolla
authors.forename: Joaquín Gómez
authors.initials: JG
authors.lastname: Gómez
authors.forename: Vincente
authors.initials: V
authors.lastname: Vincente
authors.forename: Francisco
authors.initials: F
authors.lastname: Ayala
keywords: MASCC; bacteremia; febrile neutropenia; risk prediction