title: Differences in characteristics between first and breakthrough neutropenic fever after chemotherapy in patients with hematologic disease.
abstract: OBJECTIVE
  This study was conducted to compare the clinical and microbiological characteristics of first and breakthrough neutropenic fever in hematologic malignancy patients after chemotherapy.
  
  
  METHODS
  Breakthrough neutropenic fever was any episode of fever, not present initially, that developed either during antibiotic therapy or within 1 week of discontinuation of therapy. A total of 687 neutropenic fever episodes in 241 patients were observed from April 2003 to March 2014.
  
  
  RESULTS
  Blood cultures revealed 210 causative microorganisms: 199 (94.8%) were bacteria and 11 (5.2%) were fungi. Gram-negative bacteria predominated in both types of neutropenic episode (first 75% (120/160) vs. breakthrough 56% (18/32)) and the most common pathogen was Escherichia coli. Antibiotic resistance rates were higher in breakthrough episodes than first episodes (piperacillin/tazobactam 6% vs. 31%, p=0.006; ceftazidime 9% vs. 31%, p=0.025). Inappropriate empirical antibiotic treatment was also more frequent (0% vs. 19%, p=0.001), as was the 30-day mortality rate (4.3% (19/442) vs. 7.9% (19/245), p=0.058), although the latter effect was not statistically significant.
  
  
  CONCLUSIONS
  It is concluded that the epidemiological profile of breakthrough neutropenic fever is different from that of first episode fever. These data reinforce the view that pooled reporting of neutropenic fever may be misleading, and that clinicians should approach breakthrough fever as a distinct entity.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Nam
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. Electronic address: khsongmd@gmail.com.
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea.
authors.forename: Nak-Hyun
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea.
authors.forename: Moonsuk
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea.
authors.forename: Chung-Jong
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeong-Ok
authors.initials: JO
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Pyoeng Gyun
authors.initials: PG
authors.lastname: Choe
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ji-Hwan
authors.initials: JH
authors.lastname: Bang
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Soo-Mee
authors.initials: SM
authors.lastname: Bang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Myoung-don
authors.initials: MD
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005260:Female; D005334:Fever / Q000209:etiology; D005658:Fungi; D006090:Gram-Negative Bacteria; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D010397:Penicillanic Acid / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D010397:Penicillanic Acid; D002442:Ceftazidime; D010878:Piperacillin
keywords: Breakthrough infections; Febrile neutropenia; Hematologic malignancy