439. Clinical outcome and risk factors for mortality in low-risk febrile neutropenic cancer patients
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Febrile neutropenia affects heterogeneous groups in which a certain patient population is at low risk of developing serious medical complications or death. With the need for comprehensive understanding of the nature and outcome of low-risk febrile neutropenia, we performed a large scale, retrospective study to determine the clinical characteristics and outcome of low-risk febrile neutropenic cancer patients according to the MASCC score.
Methods: All of the patients with low-risk febrile neutropenia who registered at the Emergency Department of Samsung Medical Center between May 1995 and May 2007 were included.
Results: A total of 995 cases (median age, 51 years; female, 54%) were evaluated. Breast cancer (25%) and lymphoma (24%) were the most frequent underlying malignancies. Unexplained fever (UF), clinically documented infections (CDIs), and microbiologically-documented infections (MDIs) accounted for 60%, 27% and 13% of the cases, respectively. Escherichia coli was the most frequent single microorganism, followed by coagulase-negative staphylococci, S. aureus, Klebsiella, and Pseudomonas species in MDIs. The overall mortality rate was 1.6%, and the presence of pneumonia, a MDI, and fever > 5 days in duration were independent factors associated with mortality.
Conclusion: The findings that various gram-positive and gram-negative pathogens caused MDIs suggest that broad-spectrum antibiotics with anti-pseudomonal coverage should be considered, even in the management of low-risk febrile neutropenia. Although the MASCC risk score is a good predictive system for prognosis, the presence of pneumonia, a MDI, or fever of longer duration might be additional prognostic factors in the management of low-risk febrile neutropenic patients.
Doo Ryeon Chung, MD1, Young Eun Ha, MD1, Eun-Jeong Joo, MD, Mi-kyong Joung, MD3, Cheol-In Kang, MD3, Jeong-a Lee, MD3, Soo-youn Moon, MD, fellow3, Kyong Ran Peck, MD3, Kyung Mok Sohn, MD, fellow3, Jae-Hoon Song, MD1 and  Y. Ha, None..
E. Joo, None..
K. Sohn, None..
S. Moon, None..
J. Lee, None..
M. Joung, None..
C. Kang, None..
D. Chung, None..
K. Peck, None..
J. Song, None., (1)Division of Infectious Diseases, Samsung Medical Center, Seoul, South Korea, (2)Samsung Medical Center, Seoul, Korea, Republic of