title: Could Neutrophil CD64 Expression Be Used as a Diagnostic Parameter of Bacteremia in Patients with Febrile Neutropenia?
abstract: OBJECTIVE
  The aim of this study is to investigate if neutrophil CD64 expression in febrile neutropenia patients could be used as an early indicator of bacteremia.
  
  
  METHODS
  All consecutive patients older than 18 years of age who had developed febrile neutropenia episodes due to hematological malignancies were included in the study. Those patients who had significant growth in their blood cultures constituted the case group, while those who had febrile neutropenia without any growth in their cultures and who did not have any documented infections formed the control group. Blood culture bottles were incubated in the Bact ALERT 3D system (bioMerieux, France), identification and susceptibility testing were performed using an automated broth microdilution method (VITEK 2, bioMerieux), and CD64 expression analysis was performed by the flow cytometry method. C-reactive protein (CRP) was measured by turbidimetric methods (Biosystems, Spain) and erythrocyte sedimentation rate (ESR) was measured by the Wintrobe method.
  
  
  RESULTS
  In total, we prospectively evaluated 31 febrile episodes. The case group consisted of 17 patients while the control group included 14 patients. CD64 was found on neutrophils of the case group patients with a mean count of 8006 molecules/cell and of control group with a mean count of 2786 molecules/cell. CD64 levels of the case group were significantly higher than those of the control group (p=0.005). In the differentiation of the case group from the control group, a 2500 cut-off value for CD64 had significant [AUC=0.792 (0.619-0.965)] predictive value (p=0.001). In the prediction of patients with a 2500 cut-off value for CD64, sensitivity was 94.1%, positive predictive value was 76.2%, specificity was 64.3%, and negative predictive value was 90.0%. CRP levels and ESR values did not differ significantly between the groups (p=0.005).
  
  
  CONCLUSIONS
  Neutrophil CD64 expression could be a good predictor as an immune parameter with high sensitivity and a negative predictive value for bacteremia in febrile neutropenic patients.
authors.affiliation: İstanbul Bilim University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey Phone: +90 212 361 88 00 E-mail : nurefeiris@yahoo.com.
authors.forename: Nur
authors.initials: N
authors.lastname: Efe İris
authors.forename: Taner
authors.initials: T
authors.lastname: Yıldırmak
authors.forename: Habip
authors.initials: H
authors.lastname: Gedik
authors.forename: Funda
authors.initials: F
authors.lastname: Şimşek
authors.forename: Demet
authors.initials: D
authors.lastname: Aydın
authors.forename: Naciye
authors.initials: N
authors.lastname: Demirel
authors.forename: Osman
authors.initials: O
authors.lastname: Yokuş
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers; D064147:Febrile Neutropenia / Q000097:blood / Q000175:diagnosis; D005260:Female; D005786:Gene Expression Regulation; D019337:Hematologic Neoplasms / Q000097:blood / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D011446:Prospective Studies; D017452:Receptors, IgG / Q000097:blood*
chemical_list: D015415:Biomarkers; D017452:Receptors, IgG