Prognostýc Factors And Changýng Paradýgms In Febrýle Neutropenýa Epýsodes

INTRODUCTION: The epidemiology of pathogens responsible of febrile neutropenia (FEN) has changed and so did the diagnostic tools in the field of infectious diseases. This study examined the changing paradigms and prognostic factors in FEN episodes.
METHODS: This was a prospective and observational study of 145 adult patients aged 18 and older with solid tumor and hematological malignancies and who received FEN treatment at the our cancer center between April 2020 and April 2021; 176 FEN episodes developed in patients and were examined.
RESULTS: Hematological malignancy was present in 70.3% (n=102) of the 145 patients. Microbiologically-confirmed infections were seen in 46% of FEN episodes. The most common focus of infection was lower respiratory tract infections with 27.1%. In 66.2% (n=45) of FEN episodes, only gram-negative microorganisms grew while only gram-positive microorganisms grew in 19.1% (n=13). Bacteremia was significantly higher in patients with hematological malignancies versus patients with solid organ tumors (p<0.001). Deep neutropenia on day zero was associated with bacteremia (p<0.001), but the relationship between prolonged neutropenia and bacteremia could not be demonstrated (p=0.34). FEN-related mortality was 9.7% (n=17). The risk of mortality in FEN was 10.25-fold higher in patients with pneumonia and 6.05-fold higher in patients with prolonged neutropenia.
DISCUSSION AND CONCLUSION: We determined that the frequency of pneumonia increased in the FEN clinic due to the effects of newly introduced chemotherapeutics. Gram-negative microorganisms were more common in the causative profile unlike the previous decade. Pneumonia and prolonged neutropenia increase mortality. Comprehensive multicenter studies will allow for the development of new management algorithms for changing paradigms.

Febril Nötropeni Ataklarýnda Prognostik Faktörler ve Deðiþen Paradigmalar

GÝRÝÞ ve AMAÇ: Enfeksiyon hastalýklarýnýn klinik ve laboratuvar tanýsýndaki geliþmeler ve yýllar içinde deðiþen etken spektrumu kanser tedavisi süresince Febril nötropeni (FEN) ataklarýnýn güncel takibini gerekli hale getirmiþtir. Bu çalýþmada FEN ataklarýnda deðiþen paradigmalarýn ve prognostik faktörlerin araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Prospektif, gözlemsel yürütülen bu çalýþmaya, Nisan 2020-Nisan 2021 tarihleri arasýnda kanser merkezimizde FEN nedeniyle yatarak tedavi gören 18 yaþ ve üzeri solid tümörü ve hematolojik malignitesi olan 145 eriþkin hasta alýndý ve hastalarda geliþen 176 FEN ataðý incelendi.
BULGULAR: Çalýþmaya dâhil edilen 145 hastanýn %70.3’ünde (n=102) hematolojik malignite mevcuttu FEN ataklarýnýn %46’sýnda mikrobiyolojik olarak kanýtlanmýþ enfeksiyon saptandý ve en sýk enfeksiyon odaðýnýn %27.1 ile alt solunum yolu enfeksiyonlarý olduðu görüldü. FEN ataklarýnýn %66.2’sinde (n=45) sadece gram negatif, %19.1’inde (n=13) sadece gram pozitif mikroorganizma üredi. Hematolojik maligniteli hastalarda solid organ tümörlü hastalara göre bakteriyemi istatistiksel olarak anlamlý olacak þekilde daha yüksekti (p<0.001). Sýfýrýncý günde derin nötropeni olmasý bakteriyemi ile iliþkili bulunurken (p<0.001), uzamýþ nötropeninin bakteriyemi ile iliþkisi gösterilemedi (p=0.34). FEN’e baðlý mortalite %9.7 (n=17) oranýnda görüldü. FEN’de mortalite riski, pnömonisi bulunan hastalarda 10.25 kat ve uzamýþ nötropenisi olan hastalarda 6.05 kat daha fazlaydý.
TARTIÞMA ve SONUÇ: FEN ataklarýnýn klinik ve laboratuvar bulgularýnýn araþtýrýldýðý bu çalýþmada yeni kullanýma giren kemoterapötiklerin etkisiyle FEN kliniðinde pnömoni sýklýðýnýn arttýðý ve etken profilinde geçtiðimiz dekattan farklý olarak gram negatif mikroorganizmalarýn daha çok olduðu saptanmýþtýr. Ayrýca pnomoni ve uzamýþ nötropeni varlýðýnýn mortaliyeti arttýrdýðý görülmüþtür. Kapsamlý multicenter çalýþmalar, deðiþen paradigmalara yönelik yeni yönetim algoritmalarýnýn oluþturulmasýna olanak saðlayacaktýr.