Document Type



Radiation Oncology


Creative Commons Attribution LicenseFever during chemotherapy-induced neutropenia continues to be a major cause of morbidity and mortality incancer patients. Mortality depends on the duration and degree of neutropenia, bacteremia, sepsis, performance status,comorbidities and other parameters. The highest mortality rates in cancer patients hospitalized with febrile neutropenia(FN) are observed in those with documented infection. The objectives of the study were to present available tools forrisk assessment, to review pathogens causing infections in adult FN patients and to assess outcomes. Methods: Thiscross sectional study was conducted on adult culture positive FN patients admitted to the Hematology/Oncologyservice at the Aga Khan University Hospital, Karachi, Pakistan from 1st January 2009 to 31st December 2012. Highriskcriteria were defined as profound neutropenia, short latency from a previous chemotherapy cycle, sepsis orclinically documented infection at presentation, severe co-morbidity and a performance status greater than or equalto 3. All types of organisms in blood culture and the outcomes of the patients were recorded on Proforma. Results:A total of 156 patients with culture-positive febrile neutropenia were identified during the study period. The meanage was 47 years with a slight male predominance of 54%. One hundred and sixteen patients fulfilled the criteria forthe high risk group. Fifty two percent had a single high risk factor and 40 % had two. All patients harbored eithersingle or multiple bacterial organisms including gram positive, gram negative or both types. Some 34% of patientshad gram positive bacteremia, 57 % had gram negative and 9 % were infected with both. Among 73 gram positivecultures 44 % were Staphylococcus species and among 123 gram negative cultures 43 % were E. coli. One hundredand fifteen patients recovered uneventfully and could be discharged. Thirty two patients in the high risk and 9 in thelow risk groups deceased with an overall mortality of 26 %. The mean hospital stays of patients with solid tumors andhematological malignancies were 7.58 and 15.0 days, respectively. Mortality was higher in the latter group, and alsoin high risk patients with both gram positive and negative bacteremia. Conclusion: We emphasize the importance ofrisk stratification and continuous surveillance of the spectrum of locally prevalent pathogens and their susceptibilitypatterns for formulation of therapeutic regimens for febrile neutropenic patients.


Asian Pacific Journal of Cancer Prevention