title: Pattern of infection, therapy, outcome and risk stratification of patients with febrile neutropenia in a tertiary care oncology hospital in India.
abstract: BACKGROUND
  Indian febrile neutropenia (FN) data are limited, especially in adult solid tumor patients.
  
  
  OBJECTIVE
  The aim was to study patterns of presentation, source of infection, management and outcome and to evaluate the factors which may correlate with outcome.
  
  
  METHODS
  A retrospective analysis of prospective data of FN patients at a tertiary care oncology teaching hospital in India between 2007 and 2012. A standardized form was filled for each patient. Patient management was at the discretion of the treating physician. Multinational Association for Supportive Care in Cancer (MASCC) score was retrospectively calculated. Failure of therapy was defined as death, organ failure, shifting from outpatient to inpatient or requirement of intensive care support. SPSS version 16 was used for analysis.
  
  
  RESULTS
  A total of 388 FN episodes were included: 256 in hematolymphoid and 132 in solid tumor patients. 156 episodes were high-risk by MASCC score. Focus of infection was clinical in 45% and radiologic in 16%. Blood cultures were positive in 18% cases, most commonly Gram-negative organisms (72%). 93% patients were treated with an antibiotic combination of third-generation cephalosporin/beta-lactamase inhibitor, with aminoglycoside or fluoroquinolone. Antibiotic sensitivity to ceftriaxone was low at 38% while sensitivity to cefoperazone/sulbactam and piperacillin/tazobactam ranged between 50% and 55% and for carbapenems 75%. Failure of therapy occurred in 156 episodes, most commonly due to the need for second line antibiotics. Mortality was 5.5%. On univariate analysis, MASCC score, age, type of malignancy, prophylactic growth factors, presence of focus of infection, hemoglobin and nadir platelet count correlated with FN complications.
  
  
  CONCLUSIONS
  Gram-negative bacteremia continues to be the predominant cause of FN in our setup.
authors: V
authors: V
authors: Noronha
authors: A
authors: A
authors: Joshi
authors: V M
authors: VM
authors: Patil
authors: B
authors: B
authors: Bhosale
authors: V K
authors: VK
authors: Muddu
authors: S
authors: S
authors: Banavali
authors: R
authors: R
authors: Kelkar
authors: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors: K
authors: K
authors: Prabhash
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D002173:Cancer Care Facilities; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000150:complications* / Q000382:microbiology; D002648:Child; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India; D007938:Leukemia / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents