Secondary Infections in Febrile Neutropenia in Hematological Malignancies: More Than Another Febrile Neutropenic Episode.
BACKGROUND
Febrile neutropenic episodes (FNEs) are among major causes of mortality in patients with hematological malignancies. Secondary infections develop either during the empirical antibiotic therapy or one week after cessation of therapy for a FNE. The aim of the study was to investigate the risk factors associated with secondary infections in febrile neutropenic patients.


METHODS
We retrospectively analyzed 750 FNEs in 473 patients between January 2000 and December 2006.


RESULTS
Secondary infections were diagnosed in 152 (20%) of 750 FNEs. The median time to develop secondary infection was 10 days (range 2-34 days). The duration of neutropenia over 10 days significantly increased the risk of secondary infections (p<0.001). The proportion of patients with microbiologically documented infections was found to be higher in primary infections (271/750, 36%) compared to secondary infections (43/152, 28%) (p=0.038). Age, sex, underlying disease, antibacterial, antifungal or antiviral prophylaxis, blood transfusion or bone marrow transplantation, central venous catheter or severity of neutropenia did not differ significantly between primary and secondary infections (p>0.05) While fever of unknown origin (FUO) (p=0.005) and catheter-related bacteremia (p<0.001) were less frequently observed in secondary infections, the frequency of microbiologically (p=0.003) and clinically (p<0.001) documented infections, fungal pneumonias (p<0.001), infections related with gram positive bacteria (p=0.04) and fungi (p<0.001) and 30-day mortality rate (p<0.001) were significantly higher in secondary infections (p<0.001).


CONCLUSIONS
Secondary infections should be regarded as life-threatening complications of febrile neutropenia. Secondary infections represent a more severe and mortal complication and cannot be regarded just as another febrile neutropenic episode.
Aslıhan
A
Demirel
Fehmi
F
Tabak
M Cem
MC
Ar
Bilgül
B
Mete
Şeniz
Ş
Öngören
Mücahit
M
Yemişen
Reşat
R
Özaras
Emre
E
Eşkazan
Zafer
Z
Başlar
Ali
A
Mert
Teoman
T
Soysal
Burhan
B
Ferhanoğlu
Yıldız
Y
Aydın
Recep
R
Öztürk
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology; D060085:Coinfection / Q000453:epidemiology / Q000209:etiology*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000150:complications*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000209:etiology*; D009894:Opportunistic Infections / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents