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Pichereau, Solen, Anne Le Louarn, Thierry Lecomte, Hélène Blasco, Chantal Le Guellec, and Hélène Bourgoin. "Cost-Effectiveness of UGT1A1*28 Genotyping in Preventing Severe Neutropenia Following FOLFIRI Therapy in Colorectal Cancer." Journal of Pharmacy & Pharmaceutical Sciences 13, no. 4 (January 3, 2011): 615. http://dx.doi.org/10.18433/j3wk5s.
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PURPOSE: Functional polymorphisms of the UGT1A1 gene, particularly the UGT1A1*28 variant, are associated with the severity of the bone marrow suppression in patients with metastatic colorectal cancer receiving irinotecan. This study assesses the cost-effectiveness of screening for UGT1A1*28 polymorphism associated with primary prophylactic Granulocytes Colony Stimulating Factor in patients homozygous for the *28 allele. The effectiveness was estimated based on the number of neutropenia avoided. METHODS: We modelled a theoretical population treated with combined 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) for metastatic colorectal cancer. A decision tree simulated the health outcomes, measured by the prevalence of neutropenic events for two strategies, with or without UGT1A1 genotype screening. The model incorporated direct hospital costs and was validated with a sensitivity analysis. We calculated the cost-effectiveness ratio: CE=∆C / ∆E = "genotyping" cost – "no genotyping" cost / number of febrile neutropenia avoided. RESULTS: In the "genotyping strategy", the cost to avoid one febrile neutropenia event per 1000 patients treated was € 942.8 to € 1090.1. The sensitivity analysis showed a better CE ratio of € 733.4 to € 726.6 per febrile neutropenic event avoided.CONCLUSIONS: UGT1A1 genotype screening before irinotecan treatment is a cost-efficient strategy for the hospital. Systematic genotyping prior to chemotherapy, and administration of CSF in patients homozygotes for the *28 allele allow to avoid 91 febrile neutropenias at an acceptable cost.
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Sugahara, Hiroyuki, Masao Mizuki, Sayoko Matsumae, Yoshiko Nabetani, Motoko Kikuchi, and Yuzuru Kanakura. "Footwear Exchange Has No Influence on the Incidence of Febrile Neutropenia in Patients Undergoing Chemotherapy for Hematologic Malignancies." Infection Control & Hospital Epidemiology 25, no. 1 (January 2004): 51–54. http://dx.doi.org/10.1086/502292.
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AbstractObjective:To determine whether footwear exchange affects the incidence of febrile neutropenia among patients undergoing chemotherapy for hematologic malignancies.Design:Open trial with historical comparison.Setting:The 12-bed high-efficiency particulate air-fil-tered hematology unit at Osaka University Hospital, Suita, Japan.Patients:Those with hematologic malignancies who underwent chemotherapy from January 1997 through January 2003. Footwear exchange was discontinued in January 2000.Methods:The surveillance system was based on the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Rates of febrile neutropenia were calculated for neutropenic patient-days (ie, days with neutropenia < 500/μL).Results:From January 1997 through December 1999 and from February 2000 through January 2003, 58 and 54 patients endured 237 and 184 neutropenic periods following chemotherapy, and their total neutropenic days were 3,123 and 2,503, respectively. They showed episodes of febrile neutropenia 89 and 68 times, respectively. Infection rates were 28.5 and 27.2 per 1,000 neutropenic patient-days (P = .83), respectively.Conclusion:The incidence of febrile neutropenia was not affected by footwear exchange. In hematology units, changing shoes does not appear to affect the rate of infections during neutropenic periods.
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Strojnik, Ksenija, Ksenija Mahkovic-Hergouth, Barbara Jezersek Novakovic, and Bostjan Seruga. "Outcome of severe infections in afebrile neutropenic cancer patients." Radiology and Oncology 50, no. 4 (December 1, 2016): 442–48. http://dx.doi.org/10.1515/raon-2016-0011.
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Abstract Background In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test. Results We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). Conclusions Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy.
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Lee, Pauline, Randall W. Knoebel, Jennifer Pisano, and Natasha N. Pettit. "Moxifloxacin versus levofloxacin for antibacterial prophylaxis in acute leukemia patients." Journal of Oncology Pharmacy Practice 25, no. 3 (January 8, 2018): 758–61. http://dx.doi.org/10.1177/1078155217752074.
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Objective The primary endpoint of this study was to determine the incidence of febrile neutropenia among patients receiving either moxifloxacin or levofloxacin for antibacterial prophylaxis. Secondary endpoints were number of documented infections and in-hospital mortality in patients who develop febrile neutropenia. Methods A single-center retrospective cohort analysis at a large tertiary care academic medical center was conducted. This study included adult acute leukemia patients (age ≥18 years old) who received inpatient antibacterial prophylaxis (moxifloxacin or levofloxacin) from 1 July 2012 to 1 October 2014. Patients were excluded from the study if they were treated with antimicrobial therapy in the preceding five days or admitted to the hospital with neutropenic fever. Fisher’s exact test was used for categorical data and Mann–Whitney test for continuous data. Logistic regression analysis was used to determine risk factors for febrile neutropenia. Results Eighty-five patients were included in the final analysis with 40 patients who received moxifloxacin and 45 patients who received levofloxacin. Baseline characteristics were similar between the two groups. Twenty-two patients experienced febrile neutropenia requiring intravenous antibiotics in the moxifloxacin group and 30 patients in the levofloxacin group (P = 0.190). Age and duration of neutropenia appeared to predict for febrile neutropenia; however, after multivariate analysis, longer duration of neutropenia was shown to be the best predictor for febrile neutropenia with an odds ratio of 4.69 (95% CI, 1.697–12.968). Both groups had similar rates of documented infections and in-hospital morality. Conclusion Moxifloxacin and levofloxacin showed similar rates of febrile neutropenia when used for neutropenic antibacterial prophylaxis in acute leukemia patients.
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Nyatsanza, Ignatius, Irum Khan, Jennifer Windhorst, Nicole Gerardo, Kasandra Cadman, LeeAnn Valero, Eileen Knightly, Lawrence Eric Feldman, William Galanter, and Neeta K. Venepalli. "Timely antibiotic administration in febrile neutropenia." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 204. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.204.
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204 Background: The University of Illinois currently lacks a standard process to ensure timely antibiotic administration for patients with febrile neutropenia. The Infectious disease society of America (IDSA) guidelines recommend administration of antibiotics within two hours. Given the variability in patient encounters, we sought to implement an early identification and interventional strategy in the ambulatory setting for febrile neutropenic patients. A retrospective chart review over 10 weeks demonstrated that of 40 patients diagnosed with neutropenia 15 % (N = 6) had febrile neutropenia. Of these 6 patients, 50% (N = 3) received antibiotics within the IDSA time frame. We aimed to increase the percentage of febrile neutropenic patients receiving antibiotics within 2 hours from 50% to 100% in 8 weeks. Methods: A focus group at our quarterly morbidity mortality and improvement conference brainstormed a list of causes of delay in antibiotic initiation based on an index case discussion. A task force generated a pareto chart after affinity sorting the prior list, and created actual and ideal process maps, from identification of neutropenic patients to patient disposition. A standard operative protocol (SOP) was developed involving the creation and implementation of an electronic provider generated neutropenia check list triggering specific actions per IDSA recommendations, and a standardized order set including STAT cultures, and STAT antibiotics. Results: The febrile neutropenia SOP will be piloted over an 8 week period starting in early November in four ambulatory settings. The primary outcome data is the time from event to antibiotic administration. Process data will include time from event to antibiotic order, time from antibiotic order to administration and compliance with high risk neutropenic check list. We plan to assess our interventions every 3-4 weeks, and pilot at least 2 PDSA cycles within the next 8 weeks. Conclusions: Although febrile neutropenia is a recognized medical emergency with clear guidelines on treatment, not all patients may receive antibiotics within the appropriate time frame. It is therefore imperative for institutions to be aware of their level of IDSA compliance and implement appropriate quality improvements as required.
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Raufi, Ali Mehmood, Shada Attraplsi, and Yehuda Z. Lebowicz. "Better utilization of neutropenic precautions and adherence to guidelines to improve cost effectiveness and patient convenience." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 227. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.227.
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227 Background: Cancer patient are generally immunocompromised and are at increased risk of infections once absolute neutrophils count is less than 500. The aim of the study to evaluate the inpatient utilization of a standardized neutropenic precautions in cancer patients admitted with febrile neutropenia. Methods: From Jan 2010 to May 2015, established cancer patients were included in this retrospective study who were admitted in Cabel Huntington hospital, Huntington, WV with a diagnosis of febrile neutropenia and were placed on Neutropenic precautions (NP). We analyzed if NP were discontinued once patient is stable and no longer neutropenic during hospital stay. Results: A total of 159 cancer patients with admitting diagnosis of febrile neutropenia were identified. 107 out of 159 (67%) patients had solid malignancies while 33% had hematologic malignancies. Median age was 61 (Range of 20-88 years). 69 patients were male while 90 patients were female. Median duration of Neutropenic precautions (NP) was 4 (Mean 5.69 and range: 1-35). NP were appropriately discontinued in 30% of patients during hospital stay however approximately 70% of patients continued to be on NP even after neutropenia resolved (48 vs 111 patients). Median duration of unnecessary NP was 3 with a mean of 3.87 and range of 1-18 days. Conclusions: Better utilization of Neutropenic precautions and adherence to guidelines will improve overall cost effectiveness as well as patient convenience by avoiding unnecessary restriction.
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Da Silva, Thamires Branco, Guilherme Rossi Assis de Mendonça, Maiara Marx Luz Fiusa, Brunna Eulalio Alves, Rodolfo Monteiro Enz Hubert, Melina Veiga Rodrigues, Vanessa Miho Tani, Jose Vassallo, Fabio Rogério, and Erich Vinicius De Paula. "Sepsis in Patients with Febrile Neutropenia: A Clinical and Autopsy-Based Study." Blood 126, no. 23 (December 3, 2015): 4622. http://dx.doi.org/10.1182/blood.v126.23.4622.4622.
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Abstract Introduction: Sepsis in febrile neutropenia (FN) is a life threatening condition, and a health problem of increasing proportions. Although multiple organ dysfunction syndrome (MODS) frequently precedes death in patients with sepsis, the ultimate mechanisms responsible for organ dysfunction and tissue damage in sepsis are yet to be determined. Currently, tissue damage is attributed to an exacerbated response of the immune and hemostatic systems, mediated by endothelial cells, platelets and neutrophils. Of note, recent evidence demonstrated that neutrophils, platelets and fibrin participate in this response by mediating neutrophil extracellular traps (NET) formation, and promoting the hemostatic containment of infectious foci. In animal models, down-regulation of NET formation, coagulation and platelet activation are usually associated with deficiencies in pathogen clearance. Unfortunately, activation of hemostasis and NET formation could potentially contribute to tissue damage by a process called "immunethrombosis". Although the increase of sepsis severity in patients with severe neutropenia is well described, the mechanisms of sepsis-associated tissue damage in the context of severe neutropenia/thrombocytopenia are yet to be determined. Methods: In order to investigate the mechanisms of tissue damage in the context of severe neutropenia/thrombocytopenia, we compiled clinical data from two different prospective sepsis cohorts (A, neutropenic; n=129; and B, non-neutropenic; n=30) followed at our Institution. In addition, we reviewed histopathological data from 16 autopsies of individuals with hematological malignancies and septic shock from our institution (cohort C; n=16). H&E-stained slides from liver, kidneys and lungs were systematically analyzed by one investigator, and reviewed by 2 experienced pathologists, all of them blind to the presence or absence of neutropenia and thrombocytopenia. In each organ, we characterized (as present or absent) three main organic lesions: thrombi in microvessels, microorganism colonies, and inflammatory infiltrate (mononuclear and polymorphonuclear). Inflammation was graded as weak or intense, and only considered when there was no neoplastic infiltration. Results: Median ages of patients from cohorts A and B were respectively 46.0 years (13-78), and 59.4 years (22-85); P<0.0001. In cohort A, neutrophil counts were < 100/mcl in 55.8% of patients and between 100-500/mcl in 42.6%. Platelet counts were also lower in cohort A (30,126 vs 213,933/mcl; P<0.0001). Median SOFA scores (at admission) were 4 (0-15) and 5 (0-17); P=0.3 in neutropenic and non-neutropenic patients respectively, and sepsis-related mortality was 22.5% and 10.3% in the same groups (P=0.19). Among patients with a higher SOFA score, mortality was higher in neutropenic patients (100% vs 33.3%; p=0.04). The frequencies of clinically-evident infection foci were 60% in cohort A and 100% in cohort B (P=0.0001). In contrast, positive blood cultures were present in 38% of neutropenic, but in only 3.3% of non-neutropenic patients (P<0.0001). The autopsy-based study included 10 patients with lymphoma and 6 with acute leukemia. The cause of death was septic shock in all of them, and three patients presented severe neutropenia (<500/mcl). The main histological findings are shown in table 1. The only neutropenic patient with microthrombi presented AML-M3 and leukostasis. Using H&E staining, no bacterial colonies were found in any slide. Conclusions: as expected, septic patients with severe neutropenia presented a worse outcome compared to non-neutropenic patients in our cohort. In addition, the lower frequency of clinically-defined infectious foci, coupled with a strikingly higher frequency of positive blood cultures, suggest that severe neutropenia and thrombocytopenia could impair pathogen containment and clearance. Severe neutropenia/thrombocytopenia was compatible with inflammatory infiltrates and microvascular thrombosis in lungs, although the latter was only observed in a patient with leukostasis and promyelocityc acute leukemia. Table 1. Histological findings in autopsies of neutropenic and non-neutropenic patients Microthrombi Inflammation (weak/intense) Lungs Kidney Liver Lungs Kidney Liver Neutropenic 33% 33% 0% 50%/50% 0%/0% 0%/0% Non-neutropenic 56.25% 25% 6.25% 70%/20% 34%/9% 67%/0% Disclosures No relevant conflicts of interest to declare.
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Demirel, Aslıhan, Fehmi Tabak, M. Cem Ar, Bilgül Mete, Şeniz Öngören, Mücahit Yemişen, Reşat Özaras, et al. "Secondary Infections in Febrile Neutropenia in Hematological Malignancies: More Than Another Febrile Neutropenic Episode." Turkish Journal of Hematology 32, no. 3 (September 5, 2015): 243–50. http://dx.doi.org/10.4274/tjh.2013.0422.
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Rattanathammethee, Thanawat, Pokpong Piriyakhuntorn, Sasinee Hantrakool, Chatree Chai-Adisaksopha, Ekarat Rattarittamrong, Adisak Tantiworawit, Lalita Norasetthada, et al. "Gut Microbiota Profiles of Treatment-Naïve Adult Acute Myeloid Leukemia Patientswith Neutropenic Fever during Intensive Chemotherapy." Blood 136, Supplement 1 (November 5, 2020): 38–39. http://dx.doi.org/10.1182/blood-2020-140936.
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Background : The intestinal bacterial flora of febrile neutropenic patients has been found to be significantly diverse and may play a role in clinical decisions regarding antimicrobial de-escalation with predictive complications. However, there are few reports of microbiota alteration of adult acute myeloid leukemia (AML) patients. Methods : Stool samples of each treatment-naïve AML patient were collected the day before the initiation of induction chemotherapy (pretreatment), on the first date of neutropenic fever and first date of bone marrow recovery. Bacterial DNA was extracted from stool samples and bacterial 16s ribosomal RNA genes were sequenced by next-generation sequencing. Relative abundance, overall richness, Shannon's diversity index and Simpson's diversity index were calculated. Results : Ten AML patients (4 men and 6 women) were included with a median age of 39 years (range: 19-49). Twenty-four stool samples were collected and assigned into three groups: (1) pretreatment (n = 10); (2) first date of febrile neutropenia (n=9); and (3) first date of bone marrow recovery (n=5). All of patients developed febrile neutropenia; three patients had detectable infectious organisms and all of these cases had invasive pulmonary aspergillosis with two being co-infected with Pseudomonas pneumonia and Escherichia coli septicemia. Median absolute neutrophil count was 2.85 x 109/L (range: 1.42-7.67 x 109/L), 0.04 x 109/L (range: 0.01-0.43 x 109/L) and 3.65 x 109/L (range: 2.09-5.78 x 109/L) at pretreatment, first date of febrile neutropenia and first date of bone marrow recovery, respectively. At the phylum level, Firmicutes dominated over the period of neutropenic fever, subsequently declining after bone marrow recovery a pattern in contrast to that shown by Bacteroidetes and Proteobacteria. At the genus level, Enterococcus was more abundant in the febrile neutropenia period compared to pretreatment (mean difference of 20.2, [95%CI (5.9, 34.6)]; P <0.01) whileBacteroides and Escherichia notably declined during the same period (mean difference of -11.7, [95%CI (-21.9, -1.4)]; P= 0.027 and -11.6, [95%CI (-22.7, -0.4)]; P = 0.034, respectively). At the operational taxonomic units (OTUs) level, there was a significantly higher level of overall richness in the pretreatment period than in the febrile neutropenic episode (mean OTUs of 203.1 vs. 131.7; P = 0.012). Both of the diversity indexes of Shannon and Simpson showed a significant decrease in the febrile neutropenic period. Conclusions : Adult AML patients with a first episode of febrile neutropenia after initial intensive chemotherapy demonstrated a significant decrease in gut microbiota diversity and the level of diversity remained constant despite recovery of bone marrow. Figure Disclosures No relevant conflicts of interest to declare.
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Martinez Lago, Nieves, Maria Vieito, Urbano Anido, Sonia Candamio, Rafael Lopez, Francisco J. Barón, Yolanda Vidal, et al. "Retrospective study of febrile neutropenia." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e19505-e19505. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e19505.
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e19505 Background: Although its mortality has decreased in the last years, neutropenic fever is still one of the most important oncological emergencies. Methods: We have assessed the epidemiological data on patients admitted or evaluated for neutropenic sepsis in a third level cancer center from January 2009 to December 2010. Results: We have found 68 patients who had at least one episode of febrile neutropenia, of them 66% were male and 34% female, and the mean age was 59 years. The performance status was 0 and 1 in 80% of patients and only 19% percent had serious comorbilities such as renal dysfunction, cirrhosis, diabetes mellitus or chronic pulmonary disease. 36% of our patients had a high risk neutropenic fever per MASCC criteria. The majority of patients were lung cancer (31%) breast cancer (22%); and gastrointestinal cancer (28%) and 53% where treated with palliative intention. The episodes of febrile neutropenia were more frequent in patients in first line of treatment (72%) and first cycle of any treatment (42%). 8% of patients were treated with chemorradiation and 35% of the patients were receiving prophylaxis with GCSF. There was no found the source of the infection in 45% of patients. 25% had positive cultures. The porcetaje of infections with gram-positive and-negative was very similar. Patients were treated with a combination of amikacine and ceftacidime in 63% of times, further addition of vancomicine or antifungical therapies were only needed in minority of patients, 88% percent of patients received granulocyte stimulating factors. The mean duration of the neutropenia was of 2 days. Following chemotherapy treatment doses were reduced in 44% of patients and delayed in 26%. Thirteen percent of patients received secondary prophylaxis with GCSF, treatment regimen changed was changed in only 2% of patients and 29% received no further treatment. Conclusions: The mortality rate was of 3%, and the time of hospitalization was short (mean of 7 days). Febrile neutropenia remains a serious complication that we have to decrease.
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Kukec, Renata Rezonja, Iztok Grabnar, Tomaz Vovk, Ales Mrhar, Viljem Kovac, and Tanja Cufer. "Febrile neutropenia in chemotherapy treated small-cell lung cancer patients." Radiology and Oncology 49, no. 2 (June 1, 2015): 173–80. http://dx.doi.org/10.2478/raon-2014-0050.
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Abstract Background. Chemotherapy with platinum agent and etoposide for small-cell lung cancer (SCLC) is supposed to be associated with intermediate risk (10-20%) of febrile neutropenia. Primary prophylaxis with granulocyte colonystimulating factors (G-CSFs) is not routinely recommended by the treatment guidelines. However, in clinical practice febrile neutropenia is often observed with standard etoposide/platinum regimen. The aim of this analysis was to evaluate the frequency of neutropenia and febrile neutropenia in advanced SCLC patients in the first cycle of standard chemotherapy. Furthermore, we explored the association between severe neutropenia and etoposide peak plasma levels in the same patients. Methods. The case series based analysis of 17 patients with advanced SCLC treated with standard platinum/etoposide chemotherapy, already included in the pharmacokinetics study with etoposide, was performed. Grade 3/4 neutropenia and febrile neutropenia, observed after the first cycle are reported. The neutrophil counts were determined on day one of the second cycle unless symptoms potentially related to neutropenia occurred. Adverse events were classified according to Common Toxicity Criteria 4.0. Additionally, association between severe neutropenia and etoposide peak plasma concentrations, which were measured in the scope of pharmacokinetic study, was explored. Results. Two out of 17 patients received primary GCS-F prophylaxis. In 15 patient who did not receive primary prophylaxis the rates of both grade 3/4 neutropenia and febrile neutropenia were high (8/15 (53.3%) and 2/15 (13.3%), respectively), already in the first cycle of chemotherapy. One patient died due to febrile neutropenia related pneumonia. Neutropenic events are assumed to be related to increased etoposide plasma concentrations after a standard etoposide and cisplatin dose. While the mean etoposide peak plasma concentration in the first cycle of chemotherapy was 17.6 mg/l, the highest levels of 27.07 and 27.49 mg/l were determined in two patients with febrile neutropenia. Conclusions. Our study indicates that there is a need to reduce the risk of neutropenic events in chemotherapy treated advanced SCLC, starting in the first cycle. Mandatory use of primary G-CSF prophylaxis might be considered. Alternatively, use of improved risk models for identification of patients with increased risk for neutropenia and individualization of primary prophylaxis based on not only clinical characteristics but also on etoposide plasma concentration measurement, could be a new, promising options that deserves further evaluation.
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Tek, Ibrahim, Selami Kocak Toprak, Efe Hasdemir, Samed Rahatli, and Aysegül Yesilkaya. "Influence of Febrile Neutropenia Period on Plasma Viscosity at Malignancy." Scientific World Journal 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/507270.
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Cancer, chemotherapy, and infections all together make changes in blood rheology and may affect the defense mechanisms by changing the thrombocyte function and endothelial cell. We have examined changes of blood rheology on plasma viscosity to put on probable following criteria for starting the treatment of febrile neutropenia immediately. A total of 27 postchemotherapy patients (16 males and 11 females) with febrile neutropenia diagnosed according to international guidelines have been included into the study. The plasma viscosity of the patients whose febrile neutropenia has been successfully treated was also measured to assess the impact of the duration of neutropenia on viscosity. The plasma viscosities of the patients were significantly higher during neutropenic episode than in nonneutropenic state () except for alkaline phosphatase. All study parameters, particularly acute phase reactants, were statistically similar during both states. In the correlation of analysis with study parameters and stages, significant correlation was not observed between plasma viscosity alteration and leukocyte-neutrophil alteration, also other study parameters. We have demonstrated significantly elevated plasma viscosity in our patients during febrile neutropenic episode. Despite normal values of various parameters known to trigger plasma viscosity, particularly fibrinogen, it can be easily argued that the main mechanism may be the endothelial injury during infectious process and immune response mediated microcirculatory blood flow alterations.
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Chowdhury, Md Ashraful Haque, Akhil Ranjan Biswas, Salma Afrose, Mafruha Akhter, Tasneem Ara, Md Manirul Islam, and Mohammad Wasim. "Microbial Infection with Their Antibiotic Sensitivity Pattern in Febrile Neutropenic Patients Treated in Haematology and BMT Unit in DMCH." Haematology Journal of Bangladesh 2, no. 02 (July 13, 2018): 42–46. http://dx.doi.org/10.37545/haematoljbd201823.
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Background: Because of great concerns about mortality and morbidity due to infection in febrile neutropenic patients, the appropriate empirical antibiotic should be started immediately. Although there are established guidelines for the use of empirical therapy in febrile neutropenia, local microbiological pattern and antibiotic susceptibility should be considered for better outcome. There is paucity of data regarding the organism isolated and sensitivity in febrile neutropenic patients in Dhaka Medical College Hospital (DMCH). Objectives: The current study aimed to find out causative organisms for febrile neutropenia and to observe their antimicrobial sensitivity pattern. Materials and method: This was a prospective observational study carried out in department of haematology and BMT of Dhaka Medical college hospital during the period of October, 2014 to July, 2015. Total 104 patients experienced febrile neutropenia and both febrile blood and urine samples were collected and sent for culture. Results: Out of 104 patients male were 65 and female were 39 (M:F ratio 1.6:1) with a mean age of patients were 31.3 (±15.43) years. Majority (86.5%) of febrile neutropenic patients were post-chemotherapy of acute leukaemia. Out of 104 case 29 were positive growth in both blood and urine samples. Out of 25 blood culture positive patients’ organisms isolated were predominantly gram negative (78.6%) whereas 21.4% were gram negative. However, in urine culture equal number of organisms (4 vs 4) from both gram positive and gram negative were isolated. Gram negative microorganisms were resistance to antibiotic such as amoxicillin, ceftazidime, ceftriaxone, cefixime, cotrimoxazole and gentamicin and sensitive to antibiotic like meropenem, amikacin, ciprofloxacin and colistin. Gram positive microorganisms were almost resistance to azithromycin, cefixime, ciprofloxacin, cotrimoxazole, gentamicin and moxifloxacin but were sensitive to chloramphenicol, clindamycin and linezolid. Conclusions: Gram negative organisms were the predominant organisms in febrile neutropenic patients at our institute. They are resistant to a good number of commonly used antibiotics and sensitive to only a few antibiotics.
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Morgan, Jessica E. "Fifteen minute consultation: Fever in children being treated for cancer." Archives of disease in childhood - Education & practice edition 104, no. 3 (August 13, 2018): 124–28. http://dx.doi.org/10.1136/archdischild-2017-314718.
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Fever is a common symptom in children receiving treatment for cancer. Clinicians and families are most concerned about febrile neutropenia, though non-neutropenic fever often causes more challenging treatment dilemmas. This article provides a structured approach to the initial assessment, examination, investigation and risk assessment of children with fever during treatment for childhood cancer. Non-neutropenic fever in children with cancer is not well researched. There are no systematic reviews of its management and no National Institute for Health and Care Excellence (NICE) (or other international) guidance about what to do. Features to consider when managing non-neutropenic fever are discussed. Febrile neutropenia, meanwhile, is an oncological emergency and requires management using standard sepsis principles including administration of broad-spectrum antibiotics. Relevant NICE guidance provides a clear structure for treatment. Ongoing management depends on the response to initial treatment.
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Jurkonis, Mantas, Indrė Tamulienė, Rimantė Čerkauskienė, Arijanda Neverauskienė, Rytis Žilevičius, and Gražina Kleinotienė. "FEBRILINĖS NEUTROPENIJOS GYDYMO STANDARTAI PEDIATRIJOJE." Medicinos teorija ir praktika 21, no. 2.1 (March 10, 2015): 131–36. http://dx.doi.org/10.15591/mtp.2015.019.
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Managing cancer patients with fever and neutropenia must be considered as a medical emergency since any delay in initiating appropriate empirical antibacterial therapy may result in high rates of mortality and morbidity. Emerging antibacterial resistance in bacterial pathogens infecting febrile neutropenic patients complicates management, and choosing the type of empirical antimicrobial therapy has become a challenge. To further complicate the decision process, not all neutropenic patients are in the same category of susceptibility to develop severe infection. This review gives a brief overview of current antimicrobial regiment strategy in febrile neutropenic cancer patients.
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Tormay, Cathy. "Febrile neutropenia." Australian Emergency Nursing Journal 1, no. 3 (October 1997): 30–32. http://dx.doi.org/10.1016/s1328-2743(97)80013-2.
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Aksu, Kenan, and Seçkin Çağırgan. "Febrile Neutropenia." Journal of Tepecik Education and Research Hospital 9, no. 2 (1999): 55–65. http://dx.doi.org/10.5222/terh.1999.38289.
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Susman, Ed. "Febrile Neutropenia." Oncology Times 26, no. 24 (December 2004): 52. http://dx.doi.org/10.1097/01.cot.0000292734.72827.70.
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Patel, Krish, and Howard (Jack) West. "Febrile Neutropenia." JAMA Oncology 3, no. 12 (December 1, 2017): 1751. http://dx.doi.org/10.1001/jamaoncol.2017.1114.
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Ellis, Michael. "Febrile Neutropenia." Annals of the New York Academy of Sciences 1138, no. 1 (September 2008): 329–50. http://dx.doi.org/10.1196/annals.1414.035.
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Samson, Kurt. "Febrile Neutropenia." Oncology Times 36, no. 12 (June 2014): 1. http://dx.doi.org/10.1097/01.cot.0000451727.49926.9a.
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Klastersky, Jean. "Febrile neutropenia." Current Opinion in Oncology 5, no. 4 (July 1993): 625–32. http://dx.doi.org/10.1097/00001622-199307000-00002.
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Naik, J. D., S. R. K. Sathiyaseelan, and N. S. Vasudev. "Febrile neutropenia." BMJ 341, dec17 1 (December 17, 2010): c6981. http://dx.doi.org/10.1136/bmj.c6981.
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Goodman, Alice. "Febrile neutropenia." Oncology Times 2, no. 7 (July 2005): 6. http://dx.doi.org/10.1097/01434893-200507000-00003.
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Klastersky, Jean. "Febrile neutropenia." Supportive Care in Cancer 1, no. 5 (September 1993): 233–39. http://dx.doi.org/10.1007/bf00366041.
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Devi, Yumkham Monica, Amit Sehrawat, Prasan Kumar Panda, and Uttam Kumar Nath. "Febrile neutropenia due to COVID-19 in an immunocompetent patient." BMJ Case Reports 14, no. 4 (April 2021): e242683. http://dx.doi.org/10.1136/bcr-2021-242683.
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While lymphopenia has been a common finding in COVID-19 infection, particularly in severe cases, febrile neutropenia has been very rarely reported in immunocompetent patients with COVID-19. Herein, we report the case of a 76-year-old hypertensive and diabetic man who was hospitalised with severe COVID-19 infection and developed delayed-onset severe neutropenia with neutropenic fever, which responded to treatment with antibiotics and granulocyte colony-stimulating factor. This case highlights the importance of identifying a rare complication (febrile neutropenia on the fifth week) of COVID-19 infection in hospitalised patients by intensive monitoring and aggressive management for favourable outcomes.
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Yetmar, Zachary A., Prakhar Vijayvargiya, Pritish Tosh, and Mary J. Kasten. "2676. Effect of β-Lactam Allergy on Appropriateness of Antibiotic Use in Patients with Febrile Neutropenia." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S939. http://dx.doi.org/10.1093/ofid/ofz360.2354.
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Abstract Background Over 80% of patients with hematologic malignancies develop some form of infectious complication, most commonly febrile neutropenia. Patients with febrile neutropenia have 10% mortality, which increases if antibiotic administration is delayed past 30 minutes. Studies have suggested β-lactam allergy may delay administration of antibiotic while putting patients at greater risk for inappropriate antibiotic choice and adverse effects stemming from this. We sought to describe the risks associated with β-lactam allergy in the neutropenic population. Methods We conducted a retrospective, descriptive study from January 2016 to December 2017 identifying patients with febrile neutropenia and a reported history of β-lactam allergy. Baseline characteristics, allergy data, treatment data, and outcomes were collected and analyzed. Results We identified 31 patients with febrile neutropenia and β-lactam allergy during this time period. Etiologies of neutropenia were hematologic malignancy (61.2%), stem cell transplantation (12.9%), solid-organ malignancy (22.6%), and autoimmune (3.3%). Reported reactions to β-lactams were rash (41.9%), hives (9.7%), anaphylaxis (3.2%), other (9.7%), and unknown (35.5%). Average time to antibiotic administration was 142.5 minutes. Antibiotic choice was cefepime (61.3%), piperacillin–tazobactam (6.5%), carbapenem (22.6%), fluoroquinolone (6.5%), cefepime and fluoroquinolone (3.2%), and vancomycin (58.1%). 51.6% received initial antibiotics consistent with the 2010 IDSA guidelines. Six patients underwent penicillin skin testing, all negative. 1 patient developed C. difficile infection, 1 developed MRSA colonization, and 3 developed VRE colonization. Mortality was 3.2% at 30 days and 16.1% at 90 days. Conclusion Our study estimated the antibiotic usage patterns and outcomes in patients with febrile neutropenia and reported β-lactam allergy. This showed low adherence to an established guideline for antibiotic choice in these patients. With rising antimicrobial resistance, there is a need to develop strategies to reduce inappropriate antimicrobial use, especially in patients with febrile neutropenia. Preemptive β-lactam allergy evaluation warrants further evaluation in the neutropenic population. Disclosures All authors: No reported disclosures.
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Aydogan, Gonul, Gonca Keskindemirci, Deniz Tugcu, Ferhan Akici, Zafer Salcioglu, Arzu Akcay, Hulya Sen, et al. "Granulocyte Transfusion in Febrile Neutropenia." Blood 126, no. 23 (December 3, 2015): 4612. http://dx.doi.org/10.1182/blood.v126.23.4612.4612.
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Abstract Background: Over last 30 years cure rates are increasing among oncology patients. As the therapy intensifies, infectious complications become more common. Neutropenia is defined as neutrophil counts of <500/mm³ and it is one of the most frequent and severe complications of pediatric cancer therapy. In 12-17% of patients with febrile neutropenia, there are proven bacteremia and fungal infections. Pediatric oncology patients have a frequency of 30 morbidity and 1% mortality due to infections. Granulocyte transfusions (GTX) were found to be an effective protective and therapeutic strategy in prolonged neutropenia. GTX had been shown to be limiting the duration and complications of neutropenic period, maximum levels of CRP and duration of antibiotic usage especially after myeloablative therapy. Materials and methods: In this study that was performed at Kanuni Sultan Süleyman Education and Research Hospital pediatric hematology-oncology unit, 170 granulocyte transfusions applied to 37 high risk febrile neutropenia attack of 23 patients were evalauted retrospectively. Granulocyte transfusions were done when the neutrophile counts were between 0 to 300 /mm³ by taking account the general status, physical examination and cultures of patients. Donors were selected according to blood types and their informed cosent were taken. The donors came to the unit one night before, 8 mg intramuscular dexamethasone and 480 mcg of G-CSF were applied. After 12 hours, granulocytes were taken from the donors by intermittent flow technique and given to patients intraveneously. The time needed for getting away from neutropenia, number of febrile days and observed adverse effects were recorded. Results: For 23 high risk febrile neutropenic patients, granulocyte transfusion was performed at an average of 1-27 times per attack, totally 170 times in 37 attack. Eight of the patients were girls and 15 were boys, ages were ranging between 6 months to 16 years. Product quality qas found to be 1.41 x 1010; 2,14 x 1010/m2. Mean days for subsiding of fever was 6.45 days, mean time for getting rid of neutropenia was 8.15 days. Three patients died during neutropenia attacks. Two of them had both infections and uncontrolled progressive primary disease. Only one patient was lost from infection even though he had antibiotic, antifungal and supportive therapy. Only upper respiratory disease symptoms were noted at 3 of the donors. In one of the patients, transfusion was stopped due to allergic reactions. No other adverse reactions were noted. Conclusion: Our results were similar to the literature and it shows that granulocyte transfusions after myeloablative therapy limits the neutopenic period, decrease complications of neutropenia, maximum level of CRP and the duration and number of antibiotic usage. But stil controlled studies done at larger cohorts are needed. Disclosures No relevant conflicts of interest to declare.
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Chow, E. J., and K. D. Bishop. "Painless neutropenic enterocolitis in a patient undergoing chemotherapy." Current Oncology 23, no. 5 (October 26, 2016): 514. http://dx.doi.org/10.3747/co.23.3119.
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Case Description A 60-year-old man developed painless neutropenic enterocolitis after induction chemotherapy for newly diagnosed acute myelogenous leukemia. The patient had recurrent fever while neutropenic, without experiencing abdominal pain or tenderness on physical examination. His diagnosis was delayed by the fact that he had no localizing symptoms.Discussion Neutropenic enterocolitis is a common complication, generally occurring in patients who are severely neutropenic; the condition presents with fever and abdominal pain. No cases of painless neutropenic enterocolitis have yet been reported. Review of the literature shows that patients can develop this condition in the absence of fever and, sometimes, neutropenia. Furthermore, few comprehensive studies or reviews have investigated the utility of computed tomography imaging in identifying a source for abdominal pain in neutropenic patients with fever.Summary Many potential causes of febrile neutropenia should be considered in chemotherapy patients.
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Huang, C., S. Taylor, N. S. Majhail, M. Pabla, A. Malani, and J. Singh. "Hypogammaglobulinemia increases the risk of chemotherapy associated febrile neutropenia in patients with chronic lymphocytic leukemia." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 18549. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.18549.
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18549 Background: Infections are the major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). Hypogammaglobulinemia, in general, increases the susceptibility to infections in patients with CLL. We conducted a case-control study to investigate whether hypogammaglobulinemia (Immunoglobulin-G (IgG) level <600 mg/dL) increases the risk of febrile neutropenic episodes in CLL patients with chemotherapy associated neutropenia (absolute neutrophil count (ANC) <0.5 × 109/L). Methods: The source cohort consisted of all consecutive patients with CLL seen at our institution between Jan 2002 to June 2005.We identified 8 cases of chemotherapy associated febrile neutropenia; controls consisted of 18 patients, with neutropenia but no fever (n = 4) or no neutropenia (n = 14). Results: The two groups were comparable except for a higher proportion of patients with Rai stage-4 disease in the febrile neutropenia cohort (100% vs. 17%, p < 0.001). Eight of the 8 patients in febrile neutropenia group were found to be hypogammaglobulinemic as compared to 2 of 18 controls (100% vs 11%, P value < 0.001). The median IgG level was 400 mg/dL (range, 300–488 mg/dL) in the febrile neutropenia group compared to 820 mg/dL (range, 121–1700 mg/dL) in the control group (p = 0.003).The relative risk of developing chemotherapy associate febrile neutropenia in the presence of underlying hypogammaglobulinemia was 4.5 (95% confidence intervals, 1.9–10.7). Conclusions: Patients with CLL who are hypogammaglobulinemic are candidates for prophylactic administration of intravenous immune-globulin prior to initiation of myelosuppressive chemotherapy. [Table: see text] No significant financial relationships to disclose.
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Lyman, Gary H., Eva Culakova, Marek S. Poniewierski, Jeffrey Crawford, David C. Dale, and Nicole M. Kuderer. "Personalizing Cancer Supportive Care: Predicting Neutropenic Complications in Patients Receiving Intermediate Risk Cancer Chemotherapy." Blood 118, no. 21 (November 18, 2011): 1022. http://dx.doi.org/10.1182/blood.v118.21.1022.1022.
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Abstract Abstract 1022 Background: Neutropenic complications represent important dose-limiting toxicities of cancer chemotherapy. We recently developed and validated a risk model for neutropenic complications in patients with solid tumors or lymphoma receiving cancer chemotherapy (Lyman et al. Cancer 2011). While practice guidelines recommend primary colony-stimulating factor (CSF) prophylaxis for patients at >20% risk of febrile neutropenia (FN), many patients receive chemotherapy regimens associated with an intermediate risk (10–20%) of FN. For these patients, the decision to give or withhold primary CSF prophylaxis is based on clinical judgment. We report here the ability of the risk model to identify patients with individual characteristics placing them at high risk for neutropenic complications among patients receiving intermediate risk chemotherapy regimens. Methods: A prospective cohort study was conducted of consenting patients initiating a new chemotherapy regimen at 115 randomly selected US oncology practices between 2002–2006. The risk of cycle 1 severe or febrile neutropenia was estimated [95% CI] utilizing logistic regression analysis adjusting for key clinical factors including: planned chemotherapy, prior chemotherapy, age, abnormal hepatic or renal function, low pretreatment white blood count, and immunosuppressive medications. The cumulative incidence of severe neutropenia and FN across 4 cycles was estimated by the product limit method of Kaplan and Meier. Results: Among 3,760 patients with cancers of breast, lung, ovary, colon, or lymphoma, 2,270 received an intermediate risk chemotherapy regimen based on NCCN guidelines. Overall, in the subpopulation receiving intermediate risk regimens, severe or febrile neutropenia occurred in cycle 1 in 21.4% while FN over 4 cycles was observed in 11%, and primary CSF prophylaxis was utilized in 16.4%. The performance of the risk model was good in this subgroup with a c-statistic of 0.82 [0.80–0.84]. Among the half of patients classified as high risk based on the model despite receiving an intermediate risk chemotherapy regimen, cycle 1 severe or febrile neutropenia occurred in 38% [35%–41%] compared to 5% [4%–6%] of patients classified as low risk based on the model receiving such regimens. Model sensitivity and specificity were 89% and 61%, respectively. The cumulative risk of FN over 4 cycles of chemotherapy was 20% in predicted high risk group versus 5% in the low risk group (Figure). The majority of severe or febrile neutropenia events (67%) and FN events (55%) were observed in cycle 1. One-half of high risk patients who did not receive primary CSF prophylaxis in cycle 1 received CSF during subsequent cycles following a neutropenic event. Conclusions: Our model for predicting neutropenic complications can identify patients at high individual risk for severe neutropenia in cycle 1 or FN in the first 4 cycles of chemotherapy when receiving intermediate risk chemotherapy. This analysis emphasizes the potential value of determining an individual patient's risk of chemotherapy complications based on a validated risk model. Disclosures: Lyman: Amgen: Research Funding. Crawford:Amgen: Consultancy, Honoraria, Research Funding. Dale:Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Kuderer:Amgen: Research Funding.
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El Majzoub, Imad, Aline El Zakhem, Rola Cheaito, Mohamad Ali Cheaito, Rima Kaddoura, Maria Alkozah, and Hady Zgheib. "The utility of chest X-ray vs. computed tomography in febrile neutropenia patients presenting to the emergency department." Journal of Infection in Developing Countries 14, no. 10 (October 31, 2020): 1178–84. http://dx.doi.org/10.3855/jidc.12577.
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Introduction: Pulmonary infections are not uncommon in patients with febrile neutropenia. Physicians have agreed to perform a chest X-ray (CXR) for all febrile neutropenic patients presenting with respiratory signs/symptoms. Nevertheless, they were divided into two groups when it came to asymptomatic febrile neutropenic patients (i.e. without respiratory signs/symptoms). A superior alternative to CXR is Computed Tomography (CT). CT, in comparison to CXR, was shown to have better sensitivity in detecting pulmonary foci. The aim of our study is to compare the diagnostic performance of CT and CXR in febrile neutropenic patients presenting to the emergency department, regardless of their clinical presentation. We are also interested in the predictors of pneumonia on chest imaging.
Methodology: This is a retrospective cohort study conducted on febrile neutropenic adult cancer patients presenting to the emergency department of the American University of Beirut Medical Center.
Results: 11.4% of 263 patients had pneumonia although 27.7% had respiratory signs/symptoms. 17.1% of those who were symptomatic and did a CXR were found to have pneumonia. 41.7% of those who were symptomatic and did a CT were found to have pneumonia. 30% had negative findings on CXR but pneumonia on CT.
Conclusion: Patients with positive findings of pneumonia on chest imaging mainly had solid tumors, profound neutropenia, a higher CCI and a longer LOS. The presence of respiratory signs is the main predictor of positive pneumonia on chest imaging. CT is superior to CXR in detecting pulmonary foci in the population studied.
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Choquet, S. "Neutropenias febriles." EMC - Tratado de Medicina 11, no. 4 (January 2007): 1–5. http://dx.doi.org/10.1016/s1636-5410(07)70624-4.
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Hasan, Md Kamrul, Amin Lutful Kabir, Adnan Hasan Masud, and Md Mahbubur Rahman. "Evaluation of the Association of Bacteraemia with the Severity of Neutropenia." Haematology Journal of Bangladesh 1, no. 01 (July 31, 2017): 13–15. http://dx.doi.org/10.37545/haematoljbd20176.
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Background: Blood culture is a part of management algorithm in febrile neutropenia. However, the incidence of positive result of blood culture is decreasing and the spectrum of the causative microbial is changing over time. Objective: The objective of this study was to see the incidence of bacteraemia and its association with the severity of neutropenia. Methodology: Based on naturally occurring blood stream infection, we evaluated 47 febrile neutropenic patients using blood culture to see the incidence of bacteraemia during the period between October 2009 and October 2010. Results: The overall rate of blood culture positivity was 17% (8/47). It was found to be significantly higher in 32% (8/25) (p = 0.014) of patients with very severe neutropenia, 26.9% (7/26) (p = 0.044) positivity was found when blood culture was done on the first day of febrile episode and 41.7% (5/12) (P = 0.008) in the absence of prophylactic antibiotic. Conclusion: Blood culture was found to be a valuable tool for the evaluation of bacteraemia and should be used in all cases of febrile neutropenia.
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Nucci, Marcio, Marianne Landau, Fernanda Silveira, Nelson Spector, and Wolmar Pulcheri. "Application of the IDSA Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients: Impact on Reducing the Use of Glycopeptides." Infection Control & Hospital Epidemiology 22, no. 10 (October 2001): 651–53. http://dx.doi.org/10.1086/501839.
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AbstractWe evaluated the impact of applying the Infectious Diseases Society of America guidelines for febrile neutropenic patients in reducing the use of glycopeptides. Forty-five prior episodes of febrile neutropenia were compared to 97 episodes seen after application of the guidelines. Glycopeptide use was reduced from 73% to 43% of episodes (P=.0008), without changes in outcome.
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Cutillas-Pérez, María Mar, Cristina Macía-Rodríguez, Lucía Santomé-Couto, and Javier de la Fuente-Aguado. "Neutropenia febril." Revista Española de Casos Clínicos en Medicina Interna 5, no. 1 (April 30, 2020): 42–44. http://dx.doi.org/10.32818/reccmi.a5n1a15.
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La quimioterapia deprime la mielopoyesis y afecta a la integridad de las mucosas gastrointestinales aumentando el riesgo de infecciones sistémicas por translocación de bacterias y hongos. La neutropenia febril es una complicación grave cuya tasa de mortalidad es de hasta el 11%. Es fundamental reconocer precozmente este cuadro e iniciar antibioterapia empírica de inmediato. En pacientes sin datos de gravedad, el tratamiento ambulatorio es igual de eficaz y seguro que el hospitalario.
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Firmansyah, Rulli, Daan Khambri, Edison Edison, and Zelly Dia Rofinda. "KEJADIAN DEMAM NEUTROPENIA PADA PASIEN KANKER PAYUDARA YANG MENDAPAT KEMOTERAPI." Majalah Kedokteran Andalas 38, no. 1 (March 21, 2015): 12. http://dx.doi.org/10.22338/mka.v38.i1.p12-19.2015.
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AbstrakKemoterapi memiliki peranan penting dalam penatalaksanaan kanker payudara. Obat ini bekerjamembunuh sel-sel kanker, namun dapat juga menghancurkan sel-sel sehat termasuk sel darahsehingga dapat menyebabkan neutropenia. Penelitian ini bertujuan untuk mengetahui kejadiandemam neutropenia pada pasien kanker payudara yang mendapat kemoterapi. Jenis penelitianini adalah obsevasional dengan desain cross sectional study. Jumlah sampel sebanyak 98 orangpenderita kanker payudara yang menjalani kemoterapi di RSUP Dr. M Djamil Padang.Pemeriksaan yang dilakukan adalah differential count dan suhu tubuh oral, kemudian dilakukananalisis statistik dengan uji non parametrik. Kejadian demam neutropenia ditemukan pada 10pasien (10,2%), dimana didapatkan hubungan yang bermakna antara regimen kemoterapidengan kejadian demam neutropenia (p=0,028), dan tidak terdapat hubungan yang bermaknaantara kejadian demam neutropenia dengan umur pasien (p=0,683) serta setting kemoterapi(p=0,631). Hubungan antara kejadian demam neutropenia dengan siklus kemoterapi tidak dapatdianalisis secara statistik. Penelitian ini dapat disimpulkan bahwa regimen kemoterapi non FACmeningkatkan resiko kejadian demam neutropenia pada pasien kanker payudara yangdikemoterapi.AbstractChemotherapy has an important role in breast cancer management. Chemotherapy works bykilling cancer cells in the body. However, healthy cells including blood cells are also destroyedleading to a condition called neutropenia. This study aimed to determine the incidence ofneutropenia febrile in patients with breast cancer who received chemotherapy in thechemotherapy unit of Dr. M. Djamil Padang Hospital. This study was a cross-sectional study of98 samples. Leucosite differential count and oral body temperature were examined and wereanalyzed with non parametric test. Neutropenia febriles were found on 10 out of 98 patients(10.2%). There was a significant association found between chemotherapy regimen and theincidence of neutropenia febrile (p=0.028), however, there were no significant associationbetween the incidence of neutropenia febrile with patient’s age (p=0.683) and the setting ofchemotherapy (p=0.631). While the correlation between the incidence of neutropenia febrile andchemotherapy cycle can not be statistically analyzed. It is concluded that chemotherapy causesincidence of neutropenia febrile at 10.2% patient. Non FAC chemotherapy regimens increasesthe risk of neutropenia febrile in patients with breast cancer patient receiving chemotherapy.
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Lonial, Sagar, Rachid Baz, Arlene S. Swern, Donna Weber, and Meletios A. Dimopoulos. "Neutropenia Is a Predictable and Early Event in Affected Patients with Relapsed/Refractory Multiple Myeloma Treated with Lenalidomide in Combination with Dexamethasone." Blood 114, no. 22 (November 20, 2009): 2879. http://dx.doi.org/10.1182/blood.v114.22.2879.2879.
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Abstract Abstract 2879 Poster Board II-855 Background: Lenalidomide (len) is an immunomodulatory compound with established clinical efficacy and safety in patients with multiple myeloma (MM). Two pivotal phase III trials in patients with relapsed/refractory MM evaluating lenalidomide + dexamethasone (len + dex) vs placebo + dex (MM-009 and MM-010) demonstrated that len + dex is well tolerated with significant improvements in response and overall survival in comparison to placebo + dex (Weber et al, NEJM 2007; Dimopoulos et al, NEJM 2007). Despite a favorable safety profile, neutropenia is one of the most common hematologic adverse events in patients receiving len + dex. Patients who experience neutropenia may require dose adjustments or discontinuation of len + dex therapy. The aim of this study was to understand the incidence, onset, and duration of neutropenia in patients with relapsed/refractory MM receiving long-term administration of len + dex. Methods: Pooled data for patients treated with len + dex from the two phase III studies (MM-009/010) with a median follow-up of 48 months in all patients surviving as of the data cutoff of July 2008, were analyzed for all neutropenia reported as adverse events (neutropenic AE), including all related terms. The change in incidence and severity of neutropenic AE over time was determined by capturing the highest grade of event reported for each patient within each month. Both the severity (grades 1-4) and duration (days) of neutropenic AE were also determined for patients within each month. To evaluate the change in the rate of neutropenic AE for all patients by month, monthly rates were modeled using Poisson regression with a factor for month and the log of the total number of patients included as an offset parameter. Results: Of 353 patients treated with len + dex, 164 (46%) experienced a neutropenic AE of any grade at some point during the course of the study. A grade 3 or 4 event occurred in 137 (39%) patients. Of the patients who experienced neutropenic AE of any grade, 97 (59%) received G-CSF at some point in the study compared to 8 (4%) of the patients without neutropenic AE. Sixty percent of patients who experienced a neutropenic AE, experienced more than 1 event. Overall, neutropenic AE occurred early, with 52% and 76% of patients experiencing their most severe event within 6 and 12 months of therapy, respectively (Figure). Only 24% of patients who experienced neutropenia experienced their highest grade of event after 12 months of therapy. The median duration of neutropenic AE overall was 10 (25th percentile 8; 75th percentile 29) days. The majority of severe neutropenic AE were grade 3, with very few patients experiencing a grade 4 event. Of the 353 patients treated with len + dex, only 11 (3.1%) patients had febrile neutropenia (12 events). Seven of the patients had their first febrile neutropenia within the first 6 months and 4 patients after 12 months. Twelve patients (3.3%) had their study drug discontinued due to a neutropenic event. Overall, the incidence, severity, and the duration of any neutropenic events did not significantly change over time. Conclusions: Overall, the first neutropenic AE in patients receiving len + dex occurs early, with more than 50% of patients experiencing their highest grade of event within 6 months of initiation of therapy and only 3.1% of patients treated with len + dex developed febrile neutropenia. These data support the predictable safety profile of len + dex, thereby supporting the long-term use of len + dex in patients with relapsed/refractory MM, and demonstrating the predictable safety profile of this combination therapy. Disclosures: Lonial: Gloucester: Research Funding; Novartis: Consultancy; BMS: Consultancy; Millenium: Consultancy, Research Funding; Celgene: Consultancy. Baz:Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding. Swern:Celgene: Employment. Weber:Celgene: Honoraria, Research Funding. Dimopoulos:Celgene: Honoraria.
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Nucci, Marcio. "How I treat febrile neutropenia." Mediterranean Journal of Hematology and Infectious Diseases 13, no. 1 (February 26, 2021): e2021025. http://dx.doi.org/10.4084/mjhid.2021.025.
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The management of febrile neutropenia is a backbone of the treatment of patients with hematologic malignancies, and has evolved over the past decades. This article reviews my approach to the evaluation and treatment of febrile neutropenic patients. Key topics discussed include antibacterial and antifungal prophylaxis, the initial workup for fever, the choice of the empiric antibiotic regimen and its modifications, and criteria for discontinuation. For each of these questions, I review the literature and present my perspective.
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González Mercado, Natalia Ramona. "Clinical and microbiological characteristics associated with febrile neutropenia." Revista Virtual de la Sociedad Paraguaya de Medicina Interna 4, no. 2 (September 14, 2017): 34–41. http://dx.doi.org/10.18004/rvspmi/2312-3893/2017.04(02)34-041.
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Salako, Omolola, Kehinde Sharafadeen Okunade, Adeoluwa Akeem Adeniji, Gabriel Fagbenro, and Oluwasegun Afolaranmi. "Chemotherapy-induced neutropenia among breast cancer patients presenting to a tertiary hospital in Nigeria." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e12523-e12523. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e12523.
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e12523 Background: Neutropenia and febrile neutropenia are major dose-limiting adverse effects of systemic cancer chemotherapy. It has been associated with significant morbidity and mortality, and high costs of management, and treatment breaks in cancer patients especially in resource-limited environments leading to poorer outcomes. Chemotherapy-induced neutropenia is an established complication of breast cancer treatment, however, there is paucity of information on the exact magnitude of the condition. This study assessed the prevalence of neutropenia and febrile neutropenia, while identifying their associated factors. Methods: A cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a two-year period. Sociodemographic, clinical and haematological data was obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected after each course of chemotherapy. The National Cancer Institute Common Terminology CTCAE version 4.03 was used to assess febrile neutropenia, neutropenia and its severity. Results: The prevalence of neutropenia and febrile neutropenia among the patients was 31.9% and 5.3% respectively. Throughout all courses of chemotherapy, there were neutropenic episodes 11.4% (57/502) with mild neutropenia 6.6%, moderate 3.4% and severe 1.4%. Prevalence of neutropenia decreased with increasing chemotherapy courses, with prevalence after first course being 14.2% and last course 4.9%. Associated risk factors for developing neutropenia include increasing age ( p = 0.014), ECOG performance score > 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). Conclusions: One in three breast cancer patients developed neutropenia while on chemotherapy. The use of prophylactic G-CSF after each course of chemotherapy should be a routine practice, especially among elderly patients, unstable patients, and those with bone metastasis.
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TAMURA, Kazuo. "Clinical Management for Febrile Neutropenia." Journal of the Japanese Association for Infectious Diseases 80, no. 4 (2006): 358–65. http://dx.doi.org/10.11150/kansenshogakuzasshi1970.80.358.
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Korpelainen, Sini, Carina Intke, Sari Hämäläinen, Esa Jantunen, Auni Juutilainen, and Kari Pulkki. "Soluble CD14 as a Diagnostic and Prognostic Biomarker in Hematological Patients with Febrile Neutropenia." Disease Markers 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/9805609.
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Objective. Elevated levels of a cell surface glycoprotein, soluble cluster of differentiation 14 (sCD14), have been observed in patients with sepsis. Only scarce data are available on sCD14 in hematological patients with chemotherapy-induced febrile neutropenia. The study aim was to investigate sCD14 as an early biomarker in febrile neutropenia after intensive chemotherapy to detect a rapidly deteriorating clinical course early enough to avoid serious infectious complications.Patients and Methods. This prospective study included 87 adult hematological patients at the start of febrile neutropenia after intensive chemotherapy for acute myeloid leukemia or after autologous stem cell transplantation. The study endpoints were septic shock, severe sepsis, and positive blood culture findings. sCD14 was analyzed from day 0 to day 2, and its prognostic capacity was compared to that of C-reactive protein and procalcitonin.Results. Plasma level of sCD14 predicted the development of septic shock on day 1 (p=0.001) and day 2 but not the development of severe sepsis or blood culture positivity in hematological patients with chemotherapy-induced febrile neutropenia.Conclusions. Soluble CD14 did not predict an overall complicated course at the early stages of febrile neutropenia. However, it was helpful in predicting the progression of the clinical course of neutropenic fever to septic shock.
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Jamjumrus, Jantima, and Darika Chanpho. "บทบาทพยาบาลในการป้องกันและจัดการแก้ไขการเกิดไข้ในภาวะเม็ดเลือดขาวต่ำในผู้ป่วยมะเร็งที่ได้รับยาเคมีบำบัด ( Febrile neutropenia )." Siriraj Medical Bulletin 14, no. 3 (July 1, 2021): 61–65. http://dx.doi.org/10.33192/smb.v14i3.249761.
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การเกิดไข้ในภาวะเม็ดเลือดขาวต่ำ (febrile neutropenia) เป็นภาวะฉุกเฉินทางโรคมะเร็งที่พบได้บ่อยในผู้ป่วยมะเร็งที่ได้รับการรักษาด้วยยาเคมีบำบัด ภาวะแทรกซ้อนนี้ส่งผลทำให้ผู้ป่วยติดเชื้อในกระแสเลือด การช็อคจากการติดเชื้อ ทำให้ผู้ป่วยเสียชีวิต นอกจากนั้นยังส่งผลทำให้คุณภาพชีวิตลดลง วงรอบของการรักษานานมากขึ้น การลดขนาดยาเคมีบำบัดลงทำให้การรักษาได้ผลไม่เต็มที่ ค่าใช้จ่ายในการรักษาเพิ่มขึ้น พยาบาลจึงเป็นบุคคลที่มีบทบาทสำคัญ ดังนั้นพยาบาลจึงต้องมีความเข้าใจความหมายของการเกิดไข้ในภาวะเม็ดเลือดขาวต่ำ (febrile neutropenia) ปัจจัยที่มีผลทำให้เกิดภาวะ febrile neutropenia การคัดกรองประเมินความเสี่ยงต่อการเกิดภาวะ febrile neutropenia ในผู้ป่วยมะเร็งที่ได้รับยาเคมีบำบัดทุกราย โดยในการคัดกรองใช้แบบประเมินที่เรียกว่า แบบประเมิน MASCC Risk Index for Febrile neutropenia และแบบประเมินระดับของภาวะเม็ดเลือดขาวต่ำควบคู่กันไปเป็นระยะ รวมทั้งปฏิบัติตามแนวทางที่เป็นมาตรฐานในการรักษาพยาบาลผู้ป่วยที่เกิดภาวะ febrile neutropenia ตลอดจนแนวทางการพยาบาลในการป้องกันและจัดการดูแลแก้ไขผู้ป่วยที่มีภาวะเม็ดเลือดขาวต่ำ (neutropenia) ในผู้ป่วยมะเร็งที่ได้รับยาเคมีบำบัดทุกราย และพยาบาลต้องมีความรู้ในเรื่องขนาดยา การบริหารยา ผลข้างเคียงของยากระตุ้นเม็ดเลือดขาว (G-CSF) เพื่อใช้ในการป้องกันการเกิดภาวะ febrile neutropenia ส่งผลทำให้การรักษาพยาบาลดูแลได้อย่างถูกต้องเหมาะสมทันท่วงที ทำให้เกิดผลลัพธ์ที่ดีในการดูแลผู้ป่วย เพื่อคุณภาพชีวิตและความปลอดภัยของผู้ป่วยเป็นสำคัญ
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Flowers, Christopher R., Jerome Seidenfeld, Eric J. Bow, Clare Karten, Charise Gleason, Douglas K. Hawley, Nicole M. Kuderer, et al. "Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology Clinical Practice Guideline." Journal of Clinical Oncology 31, no. 6 (February 20, 2013): 794–810. http://dx.doi.org/10.1200/jco.2012.45.8661.
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Purpose To provide guidelines on antimicrobial prophylaxis for adult neutropenic oncology outpatients and on selection and treatment as outpatients of those with fever and neutropenia. Methods A literature search identified relevant studies published in English. Primary outcomes included: development of fever and/or infections in afebrile neutropenic outpatients and recovery without complications and overall mortality in febrile neutropenic outpatients. Secondary outcomes included: in afebrile neutropenic outpatients, infection-related mortality; in outpatients with fever and neutropenia, defervescence without regimen change, time to defervescence, infectious complications, and recurrent fever; and in both groups, hospital admissions, duration, and adverse effects of antimicrobials. An Expert Panel developed guidelines based on extracted data and informal consensus. Results Forty-seven articles from 43 studies met selection criteria. Recommendations Antibacterial and antifungal prophylaxis are only recommended for patients expected to have < 100 neutrophils/μL for > 7 days, unless other factors increase risks for complications or mortality to similar levels. Inpatient treatment is standard to manage febrile neutropenic episodes, although carefully selected patients may be managed as outpatients after systematic assessment beginning with a validated risk index (eg, Multinational Association for Supportive Care in Cancer [MASCC] score or Talcott's rules). Patients with MASCC scores ≥ 21 or in Talcott group 4, and without other risk factors, can be managed safely as outpatients. Febrile neutropenic patients should receive initial doses of empirical antibacterial therapy within an hour of triage and should either be monitored for at least 4 hours to determine suitability for outpatient management or be admitted to the hospital. An oral fluoroquinolone plus amoxicillin/clavulanate (or plus clindamycin if penicillin allergic) is recommended as empiric therapy, unless fluoroquinolone prophylaxis was used before fever developed.
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Rizvi, Qurratul Ain, Aisha Jamal, Naveena Fatima, Munira Borhany, Uzma Zaidi, and Tahir Sultan Shamsi. "Substantiation of Multinational Association for Supportive Care in Cancer (MASCC) Score in Risk Assessment of Febrile Neutropenic Patients in Hematological Disorders: A Regional Study from Pakistan." National Journal of Health Sciences 5, no. 3 (March 30, 2021): 99–103. http://dx.doi.org/10.21089/njhs.53.0099.
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Abstract: Background: The incidence of neutropenia in hematological malignancies comprises of huge burden of febrile neutropenia. Multinational Association of Supportive Care in Cancer (MASCC) risk index score is the most widely used model for forecast of complications. Objective: The aim of this study was to determine diagnostic accuracy of MASCC scoring system in febrile neutropenia patients suffering from hematological disorders. Materials & Methods: Patients suffering from hematological disorders and presenting with febrile neutropenia were stratified into low and high risk groups according to MASSC score. The standard score range from 0 to 26 points; score of more than or equals to 21 were considered to be low risk and score of less than 21 was high-risk category. As an in-patient at National Institute of Blood Disease & Bone Marrow Transplantation, they were followed over the course of illness for development of any serious medical condition until resolution of febrile neutropenia. Results: Of 217 patients, serious medical conditions were documented in (63%) of individuals among the high-risk group cohort and (13%) developed serious medical conditions in low-risk cohort. Major disease encountered was acute leukemia (69%). Hypotension 14 (22.2%) and hepatic failure 14 (22.2%) were among the two most common variables of established serious medical condition. The overall sensitivity and specificity of MASCC score was 69.8% and 81.8%, with the positive and negative predictive value of 61.1% and 86.8% respectively. Conclusion: The score has been re-validated in this study and determined its significance in ascertainment of high-risk cohort among febrile neutropenic patients in the current era, thereby helping the physicians to tailor the management approach accordingly. Keywords: MASCC, Febrile neutropenia, Leukemia, Hematological disorders, Cytotoxic chemotherapy.
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Butts, Allison R., Christina Carracedo Bachmeier, Emily V. Dressler, Meng Liu, Ann Cowden, Jeff Talbert, and Val R. Adams. "Association of time to antibiotics and clinical outcomes in adult hematologic malignancy patients with febrile neutropenia." Journal of Oncology Pharmacy Practice 23, no. 4 (January 11, 2017): 278–83. http://dx.doi.org/10.1177/1078155216687150.
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Objective The objective of this study was to determine the clinical impact of time to antibiotic administration in adult inpatients who have hematologic malignancies and develop febrile neutropenia. Methods A retrospective chart review was conducted to screen for all febrile neutropenia events amongst adult hematologic malignancy patients between 1 January 2010 and 1 September 2014. All included patients were admitted to the hospital at the time of fever onset, having been admitted for a diagnosis other than febrile neutropenia. Descriptive statistics and logistic generalized estimated equations were used to analyze the data. Results Two hundred forty-four neutropenic fever events met inclusion criteria. Thirty-five events (14.34%) led to negative clinical outcomes (in-hospital mortality, intensive care unit transfer, or vasopressor requirement), with an in-house mortality rate of 7.4%. The time to antibiotics ranged from 10 min to 1495 min. The median time to antibiotics in the events that led to negative outcomes was 120 min compared to 102 min in the events that did not lead to the negative outcome ( p = 0.93). Conditional order sets were used to order empiric antibiotics in 176 events (72.1%) and significantly reduced time to antibiotics from 287 min to 143 min ( p = 0.0019). Conclusion Prolonged time to antibiotic administration in hematologic malignancy patients who develop neutropenic fever was not shown to be associated with negative clinical outcomes.
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Lingaratnam, Senthil, Leon J. Worth, Monica A. Slavin, Craig A. Bennett, Suzanne W. Kirsa, John F. Seymour, Andrew Dalton, et al. "A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment." Australian Health Review 35, no. 4 (2011): 491. http://dx.doi.org/10.1071/ah10951.
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Background. Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration. Methods. A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria’s hospital morbidity dataset. Two-way sensitivity analyses and Monte Carlo simulation were performed to evaluate the uncertainty of costs and outcomes associated with ambulatory care. Results. The modelled cost analysis showed that cost savings for two ambulatory care strategies were ~30% compared to standard hospital care. The weighted average cost saving per episode of ‘low-risk’ febrile neutropenia using Strategy 1 (outpatient follow-up only) was 35% (range: 7–55%) and that for Strategy 2 (early discharge and outpatient follow-up) was 30% (range: 7–39%). Strategy 2 was more cost-effective than Strategy 1 and was deemed the more clinically favoured approach. Conclusion. This study outlines a cost structure for a safe and comprehensive ambulatory care program comprised of an early discharge pathway with outpatient follow-up, and promotes this as a cost effective approach to managing ‘low-risk’ febrile neutropenic patients. What is known about the topic? Febrile neutropenia is a common complication of chemotherapy for patients with cancer. There is high level evidence supporting the use of ambulatory care strategies to manage patients with febrile neutropenia who are deemed to be at low risk of developing medical complications. What does this paper add? This paper highlights a cost structure for an adequately equipped and cost-effective ambulatory care strategy suitable for Australian hospitals to manage patients with low-risk febrile neutropenia. What are the implications for practitioners? The strategy advocated in this paper affords eligible patients the choice of early discharge from hospital. It advocates for improved resource utilisation and expansion of outpatient services in order to minimise opportunity costs faced by cancer treatment facilities.
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Fonseca, Margarida. "A Propósito de “Sete Anos de Neutropenias Febris num Serviço de Medicina Interna”." Medicina Interna 26, no. 3 (September 20, 2019): 249. http://dx.doi.org/10.24950/rspmi/ce/148/19/3/2019.
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Santolaya, María E., Ana M. Alvarez, Carmen L. Avilés, Ana Becker, José Cofré, Miguel A. Cumsille, Miguel L. O'Ryan, et al. "Early Hospital Discharge Followed by Outpatient Management Versus Continued Hospitalization of Children With Cancer, Fever, and Neutropenia at Low Risk for Invasive Bacterial Infection." Journal of Clinical Oncology 22, no. 18 (September 15, 2004): 3784–89. http://dx.doi.org/10.1200/jco.2004.01.078.
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Purpose To compare outcome and cost of ambulatory versus hospitalized management among febrile neutropenic children at low risk for invasive bacterial infection (IBI). Patients and Methods Children presenting with febrile neutropenia at six hospitals in Santiago, Chile, were categorized as high or low risk for IBI. Low-risk children were randomly assigned after 24 to 36 hours of hospitalization to receive ambulatory or hospitalized treatment and monitored until episode resolution. Outcome and cost were determined for each episode and compared between both groups using predefined definitions and questionnaires. Results A total of 161 (41%) of 390 febrile neutropenic episodes evaluated from June 2000 to February 2003 were classified as low risk, of which 149 were randomly assigned to ambulatory (n = 78) or hospital-based (n = 71) treatment. In both groups, mean age (ambulatory management, 55 months; hospital-based management, 66 months), sex, and type of cancer were similar. Outcome was favorable in 74 (95%) of 78 ambulatory-treated children and 67 (94%) of 71 hospital-treated children (P = NS). Mean cost of an episode was US $638 (95% CI, $572 to $703) and US $903 (95% CI, $781 to $1,025) for the ambulatory and hospital-based groups, respectively (P = .003). Conclusion For children with febrile neutropenia at low risk for IBI, ambulatory management is safe and significantly cost saving compared with standard hospitalized therapy.