Febrile Neutropenia in Hematological Malignancies: Clinical and Microbiological Profile and Outcome
Journal Title: GUJARAT CANCER SOCIETY RESEARCH JOURNAL - Year 2018, Vol 20, Issue 1
Abstract
Febrile neutropenia (FN) is considered a medical emergency. Patients with hematological malignancies (HM) commonly experience FN. Broad spectrum antibiotics have to be started empirically to prevent complications. This study attempts to highlight the common infectious agents, their antibiotic sensitivity pattern and outcome in HM like acute myeloid leukemia (AML). Since sporadic data exist from India, this study can be a useful guide for oncologists managing FN in India and building institutional antibiotic policy. In this study, 44 patients with HM, diagnosed and treated for FN episodes with positive blood culture from April 2015 to march 2016 at GCRI, Ahmedabad were analyzed. Blood cultures of patients during febrile episodes were collected from central venous catheters and peripheral blood. Majority of the patients (84%) with FN episodes had absolute neutrophil count (ANC) less than 100/mm3. Eighty four percent patients developed FN between post chemotherapy day 6 to 10. The most common organisms isolated were gramnegative bacilli (80%), with Escherichia coli (48%) being the most frequent pathogen. All Escherichia coli were sensitive to colistin (100%), whereas sensitivity pattern to other antibiotics was as follows: 95%, 50%, 15%, 5% to tigecyclin, amikacin, meropenem, piperacillin-tazoactum respectively. Second most common organisms isolated were Acinetobacterbaumanniiand Klebsiellapneumoniae (14%). Sensitivity pattern of Acinetobacterbaumannii to piperacillin-tazoactum, meropenum, amikacin, levoflox was 100%, 100%, 83%, 16% respectively. Sensitivity of Klebsiellapneumoniae to colistin, tigecyclin, amikacin, meropenum was 100%, 50%, 33%, 16%. Overall mortality was 30%.In AML, there is high risk of developing FN on 2nd week post chemotherapy and when ANC is less than 100/mm3. Most common cause of FN is gram negative septicemia with most common organism is Escherichia coli. Sensitivity of microorganisms to various antibiotics is very predictable. Thus, one can start antibiotic empirically according to institutional sensitivity pattern and then therapy should be tailored to the most appropriate antibiotics according to the bacterial culture results
Authors and Affiliations
Ekta Vala, Harsha Panchal, Asha Anand, Apurva Patel
Keywords
Related Articles
- EP ID EP492286
- DOI -
- Views 53
- Downloads 0
Successful Management of Vincristine Induced Unilateral Ptosis in an Adult
Vincristine (VCR) is a vinca alkaloid widely used in the treatment of lymphoma, leukemia and solid tumours.VCR is neurotoxic and it usually causes peripheral neuropathy,but cranial and autonomic neuropathy are uncommon s...
Primary Adenocarcinoma of Lacrimal Gland: A Rare Case Report
Primary adenocarcinomas of the lacrimal gland are very rare which usually arise de novo. They share similar morphopathological characteristics with salivary gland tumors.We presented a case of 40 years old female with ad...
Uncontrolled Hypothyroidism and Ovarian ‘Tumors’: Cases and Review of Literature
Ovarian enlargement and ovarian cysts are associated with hypothyroidism. A decrease in ovarian volume, resolution of ovarian cysts and reversal of hyperstimulation like syndrome, has been shown to occur after the achiev...
FLT3 Protein Expression and Mutation in B Cell Acute Lymphoblastic Leukemia (B-ALL)
FLT3 is a receptor tyrosine kinase, which play important role in normal hematopoiesis activating mutations of FLT3 are commonly found in acute leukemia patients and reported to be associated with poor clinical outcome. T...
Dental Services at GCRI
Department of Dentistry provides general and special dental care to patients receiving cancer treatment for various types of cancers. A large number of patients are visiting for prophylactic dental check up prior to radi...