Evaluation of febrile neutropenic episodes in acute myeloid leukemia patients

The most important cause of mortality in febrile neutropenic episodes (FNEs) which mature after chemotherapy is infections. Therefore fewer in neutropenic patients must be accepted as an infection until the contrary is proved and broad-spectrum empric antibiotherapy must be started immediately as a standard approach. Our study includes 87 patients who have been treated because of acute myeloid leukemia in İnönü University Turgut Özal Medicine Center Adult Hematology Clinic between 2002 and 2010. The infection categories, isolated pathogen microorganisms, mortality ratios and antibiotherapy regimens in 236 febril neutropenic episodes which mature after chemotherapy have been examined retrospectively in our study.In FNEs, fewer was evaluated in %30.9 microbiologic defined infection (MDI), %40.3 clinical defined infection (CDI) and %28.8 fewer of unknown origin (FUO) categories. The mean patient episode number was estimated as 2.7. In FNEs, %19.9 efficient pathogen microorganism was isolated from blood cultures and %80.1 was not isolated. %51.1 of pathogens which isolated from blood cultures were gram-positive bacteries, %40.4 were gram-negative bacteries and %8.5 were fungus. In our study we isolated %18.2 efficient pathogen bacterium in 236 FNEs. %55.8 of isolated bacteries were gram-positive bacteries and %44.2 were gram-negative bacteries. The predominant isolated gram-positive bacteria was KNS, gram-negative bacteria was E. coli. Pneumonia was the most clinical infection seen in CDI. The mean neutropenia duration was 13.3 days in all episodes, 16.7 days in MDI, 13.1 days in CDI and 10.0 days in FUO.The mortality was %8.5 in FNEs. Mortality ratios were %9.6 in MDI, %11.6 in CDI and %2.9 in FUO. The mean neutropenia duration in exitus patients were 21.6 days and 12.6 days in living patients. This difference was statistically significant. Furthermore, combined antibacterial treatments and antifungal treatments were used in exitus patients significantly more than living patients.In conclusion, it can supply useful additive for a beter febrile neutropenia management process if the medical centers follow their infection agents closely and modify their empiric antibiotic treatment policies.