NDLI: Profile of infections and outcome in high-risk febrile neutropenia: experience from a tertiary care cancer center in India.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Ghosh, Indranil Raina, Vinod Kumar, Lalit Sharma, Atul Bakhshi, Sameer Thulkar, Sanjay Kapil, Arti
Spatial Coverage	India
Description	Country affiliation: India Author Affiliation: Ghosh I ( Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India. dr.indraghosh@gmail.com)
Abstract	Objective of the present study was to describe the profile of infections in febrile neutropenia (FN) in acute leukemia and hematopoietic stem cell transplant (HSCT) with emphasis on response to therapy and outcome. In a prospective, observational single-institutional study, consecutive episodes of high-risk FN were enrolled over a 1½-year period. Uniform antibiotic policy and response criteria were used. Of the 200 episodes enrolled, acute leukemia induction comprised 40.5%, consolidation with high-dose cytarabine 22.5%, HSCT 29% (auto-HSCT 84%), and others 8% of the episodes, respectively. Microbiologically documented infections comprised 30% episodes, while bacteremia was documented in 26% episodes. Gram-negative isolates were more common (55.7%). Cefoperazone-sulbactam had the highest in vitro efficacy against Gram-negative rods. Carbapenem resistance was most prevalent among Acinetobacter spp. (80%) and Pseudomonas aeruginosa (50%). All Gram-positive cocci other than enterococci were susceptible to vancomycin, while 2/8 enterococci were resistant to it. Cefoperazone-sulbactam and amikacin were used as first-line antibiotics. Overall mortality was 8%. On multivariate analysis, mortality was associated with a nadir leukocyte count < 200/µl and an abnormal chest radiograph. Among high-risk FN patients, inspite of a high-level of resistance to antibiotics, a frontline regime containing cefoperazone-sulbactam could restrict the use of imipenem and resulted in an acceptable mortality of 8%.
File Format	HTM / HTML
ISSN	13570560
Issue Number	2
Volume Number	29
e-ISSN	1559131X
Journal	Medical Oncology
Language	English
Publisher	Springer
Publisher Date	2012-06-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Therapy Prognosis Prospective Studies Microbiology Hematologic Neoplasms Humans Middle Aged Male Journal Article Young Adult Aspergillus Bacteria Adult Female Child Discipline Oncology Neutropenia Adverse Effects Clinical Trial Complications Mortality Drug Therapy Antineoplastic Combined Chemotherapy Protocols Hematopoietic Stem Cell Transplantation Survival Rate Combined Modality Therapy Bacteremia Anti-bacterial Agents Therapeutic Use India Pathogenicity Follow-up Studies Aspergillosis Adolescent Aged
Content Type	Text
Resource Type	Article
Subject	Hematology Cancer Research Oncology

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