The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases.
In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.
Methods: We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count <500/mm3) and fever (temperature >38.3degreesC).
Results: The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status.
Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases.
Staphylococcus species (mainly S. aureus) accounted for a high proportion of the identified Gram-positive bacteria.
Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive.
14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%.
Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia <20000/mm3.
Conclusion: Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia.
Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.
Author: Jean-Philippe LanoixEmilie PluquetFrancois-Xavier LescureHoucine BentayebEmmanuelle LecuyerMarie BoutemyPatrick DumontVincent JounieauxJean-Luc SchmitCharles DayenYoucef Douadi
Credits/Source: BMC Infectious Diseases 2011, 11:183
Published on: 2011-06-27
Copyright by the authors listed above - made available via BioMedCentral (Open Access). P