Infect Chemother.  2006 Oct;38(5):250-258.

Clinical Manifestations of Febrile Neutropenic Patients with Solid Tumor and Risk Factors for Gram Positive Bacteremia

• Ku NS
• Kim JH
• Choi YK
• Jung SJ
• Oh HJ
• Yoon KT
• Kim YA
• Shin SY
• Kim MS
• Kim YK
• Park YS
• Choi JY
• Song YG
• Lee K
• Kim JM

Abstract

BACKGROUNDS: Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor.
MATERIALS AND METHODS
We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul.
RESULTS
We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor.
CONCLUSIONS
Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.

Keyword

Solid tumor; Febrile neutropenia; Gram positive bacteremia; Clinical manifestations; Risk factors

MeSH Terms

Adolescent
Bacteremia*
Central Venous Catheters
Cohort Studies
Drug Therapy
Febrile Neutropenia
Fever
Fungi
Hematologic Neoplasms
Humans
Korea
Logistic Models
Methicillin-Resistant Staphylococcus aureus
Mucositis
Prevalence
Risk Factors*
Rivers
Seoul
Skin
Soft Tissue Infections