Our study investigated the epidemiological, microbiological, and clinical characteristics of adult inpatients with febrile neutropenia and their mortality-associated factors. To this end, we carried out a prospective, observational, multi-center study in 28 Argentinian hospitals between 2007 and 2012. We included 515 episodes of febrile neutropenia from 346 patients.
The study consisted of a multi-center, observational and prospective study of febrile neutropenia episodes in adult inpatients from 01-Aug-2007 to 02-Mar-2012, in 28 Hospital Departments of Internal Medicine in Argentina, led by investigators from the “Hospital Provincial del Centenario” University Hospital. All participating centers habitually treat patients with febrile neutropenia episodes (FNEs) according to periodically revised local protocols, following national and international guidelines and recommendations. Inclusion criteria comprised age ≥15 years, along with the presence of neutropenia and fever according to the following definitions: for neutropenia a neutrophil count below 500 / mm3; or less than 1,000 / mm3 and likely to decrease to less than 500 / mm3 in the next 48 hours; in the case of fever, presence of a single record of axillary temperature > 38.3° C, or ≥ 38° C for one hour or more.
Day 0 corresponded to the time when the patient fulfilled inclusion criteria and was included in the study. The existence of an infective source was established provided the clinician made the diagnosis of a clinically documented infection based on clinical and imaging data. A microbiological infection was confirmed, whenever a microorganism was isolated in cultured samples from a clinically suspected source.
Criteria for study completion comprised the remission of fever and neutropenia. Information on whether the patient remained in the hospital for other reason or had been released from it was recorded at that time point. Death of the patient or the referral to another care center was also regarded as end of study.
For the remission of fever, we considered values lower than 38°C for the latest 48 hours; whereas values higher than 500 neutrophils / mm3 for at least during the two preceding days were regarded as neutrophil recovery.
Procedures
Evaluation of patients consisted of a complete physical examination, biochemistry and hematology studies, sets of blood cultures, or additional samples from infected sites if needed. Recorded data included demographic and epidemiological variables, cause of neutropenia, i.e., cancer chemotherapy, underlying disease, and co-morbidities. Information on patient antecedents before day 0 included: ambulatory or hospitalized condition at the onset of FNEs, prior use of antibiotics, presence of previous fungal infection, or neutropenia episodes. Data from physical examination, routine laboratory tests on admission, blood and urine cultures, use of a central venous catheter (CVC), empiric antibiotic treatment, administration of granulocyte colony-stimulating factor (G-CSF), detection of clinical or microbiological infection, evolution and outcome (death, recovery or referral) were also recorded. The clinical source of fever was registered by the medical staff according to its location: lung, skin, gastrointestinal tract, urinary, and central nervous system, among others. The biochemistry and microbiological studies were carried out at each center according to standard procedures.
Data were analyzed by employing the SPSS package.
(2019-10-31)
