Febrile neutropenia episodes and secondary infections at patients with hematological malignancies

A total of 795 hospitalizations at Hematology Unit of Akdeniz University Hospital between January 1, 2007 and December 31, 2008 were observed at this study for development of febrile neutropenia episodes. FEN episode rate per 1000 neutropenia days was found as 74.3 and febrile neutropenia rate per 1000 patient-days was 24.4. Patients were evaluated at different categories as primary episode or secondary infection and after a follow up of 24 months, 188 patients with hematological malignancies had a total of 366 (46%) febril neutropenia episodes. Of these FEN episodes, 67,7% had clinically or microbiologically documented infection, where 14.7% of these were blood-stream infections. Of all pathogen isolates, 57.8% were Gram-negative and 39.4% were Gram-positive. Secondary infections were observed at 24.5% of primary febrile neutropenia episodes. Secondary infection episode rate per 1000 neutropenia was 14.6 and secondary infection rate per 1000 patient-days was 4.8. Of all patients with secondary infection episodes, 94.5% had clinically or microbiologically documented infections. Of all agents at secondary episodes, 32.5% were Gram-negative and 60% were Gram-positive. Infection-related mortality rate after FEN episodes were detected as 9.8%. Neutropenia duration longer than 10 days increased mortality by 7 folds, where having a MASCC score < 21 increased mortality by 8 folds. Compared to patients at remission receiving chemotherapies, newly diagnosed patients had 9-fold high mortality rates. Considering infection classification, cases of fever with unknown origin had 8.9 fold high mortality rates, compared to patients with microbiologically established focus of infection. Infection-related mortality rate after secondary episode was found as 27.8%, where it was observed that fungal infections during secondary episodes increased mortality by 17 folds. Conclusively, it was observed for our hospital that Gram-negative organisms came forward at primary FEN episodes of hematological cases and synthesis rate of wide-spectrum beta lactamase was high, and for secondary infections there was an increase at Gram-positive agents and fungal infections had influence over mortality.