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A European Organization for Research and Treatment of Cancer-International Antimicrobial Therapy Group Study of Secondary Infections in Febrile, Neutropenic Patients with Cancer
Murat Akova, Marianne Paesmans, Thierry Calandra and Claudio Viscoli
Clinical Infectious Diseases
Vol. 40, No. 2 (Jan. 15, 2005), pp. 239-245
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/4484050
Page Count: 7
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Background. Neutropenic patients with cancer may develop several episodes of fever and infection during chemotherapy-induced myeloplasia. Methods. To identify risk factors for secondary infectious episodes among patients who responded to initial antibiotic therapy, we retrospectively analyzed 2 consecutive, prospective, randomized clinical trials performed by the International Antimicrobial Therapy Group of the European Organization for Research and Treatment of Cancer during 1991-1994. Results. Of 1720 patients with their first episode of febrile neutropenia, 836 responded to the initial antibiotic regimen and were therefore suitable for our analysis. A secondary infection was observed in 129 (15%) of 836 patients that occurred at a median of 10 days (range, 1-28 days) after the onset of the primary febrile episode. Factors at both baseline and day 4 were analyzed. Age of >16 years (odds ratio [OR], 3.46; P < .001), acute leukemia in first induction (OR, 3.17; P < .001), presence of intravenous line (OR, 1.88; P = .04), severe neutropenia (defined as an absolute granulocyte count of <100 cells/mm³) on day 4 (OR, 2.72; P < .001), and type of documentation of the primary episode (i.e., microbiologically documented cause or unexplained fever; OR, 2.56; P = .001) were found to be risk factors for secondary infection. The risk of death was higher among patients who developed a secondary infectious episode than among those who did not (5.4% vs. 1.4%; P < .01). Conclusions. The clinical parameters described above may help to identify neutropenic patients at risk of developing secondary infection.
Clinical Infectious Diseases © 2005 Oxford University Press