RETROSPECTIVE EVALUATION OF EPISODES OF FEBRILE NEUTROPENIA IN PATIENTS WITH SOLID TUMORS RECEIVING CHEMOTHERAPY

Early empirical therapy with broad spectrum antibiotics remains the cornerstone of the medical approach to febrile neutropenic patients receiving chemotherapy. However, sepsis-related deaths still occur and episodes of infection are a major cause of morbidity and mortality in neutropenic patients. We retrospectively analyzed 45 episodes of febrile neutropenia in 41 patients with solid tumors receiving chemotherapy. In the majority of patients, the empirical antibiotic regimen consisted of ceftazidime (3x2 gr IV) and amikacin (1x1 gr IV). Treatment modification was done with vancomycin in 4 and with an antifungal agent (amphotericin B or fluconazole) in 14 episodes. Infection was documented with blood cultures in only three patients. The causative organisms were E. coli, C. albicans and methicillin sensitive Staphylococcus spp. Six patients died due to uncontrolled sepsis (mortality rate: %13.3). Five of these patients were older than 60 years. All had either extensive stage malignancy or serious comorbidity, and had been treated with other empirical regimens that were not consistent with the protocol of the institute. We concluded that, older age, extensive disease, severe comorbidity, and violation of the empirical treatment protocol increased mortality rate in patients with neutropenic fever.