title: An audit of febrile neutropenia cases from a rural cancer center in India.
abstract: BACKGROUND
  Data of febrile neutropenia (FN) from rural cancer centers is sparse. We did a audit of outcome of patients with FN in the period of March 2013-August 2013. The aim was to help us to develop rational antibiotic usage policies.
  
  
  METHODS
  Retrospective analysis of all consecutive patients presenting with FN. Data regarding demographic profile, tumor type, intent of treatment, chemotherapy regimen, blood culture susceptibility details, use of antibiotics, response to antibiotics and complications of FN were noted. SPSS (Statistical Product and Service Solutions) 16 was used for analysis.
  
  
  RESULTS
  67 patients had FN and there were 91 episodes. The median day of presentation with FN after start of chemotherapy was 10 days. The nadir absolute neutrophil count was 161.5 and nadir platelet count 1,00,000. The median multinational association for supportive care in cancer (MASCC) Score was 24. In accordance with MASCC there were 27 high risk FN and 64 low risk FN episodes. On multivariate analysis using logistic regression MASCC score strata was the only significant variable that predicted failure to 1st line antibiotics (P = 0.03) and mortality (P = 0.01). Nine patients (9.9%) had positive isolates on blood cultures. The blood culture isolates were predominantly Gram negative (66.7%).
  
  
  CONCLUSIONS
  The importance of developing local guidelines for rational antibiotic usage is highlighted.
authors: Department of Medical Oncology and Hematology, Malabar Cancer Center, Thallassery, Kerala, India.
authors: V M
authors: VM
authors: Patil
authors: S
authors: S
authors: Chakarborty
authors: M S
authors: MS
authors: Kumar
authors: M
authors: M
authors: Geetha
authors: S
authors: S
authors: Dev
authors: S
authors: S
authors: Samuel
authors: G
authors: G
authors: Ahmed
authors: S K
authors: SK
authors: Nayanar
authors: R
authors: R
authors: Vineetha
authors: C K
authors: CK
authors: Nair
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001424:Bacterial Infections / Q000188:drug therapy*; D002173:Cancer Care Facilities; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000150:complications*; D002648:Child; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D019035:Rural Health Services; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents