Evaluation of febrile neutropenia attacks in autologous bone marrow transplanted multiple myeloma patients

Infections are among the most common causes of mortality at patients with febrile neutropenia (FEN) after chemotherapy. Standart approach at neutropenic patients is to accept the origin of fever as infection unless proved otherwise and to start empirical wide-spectrum antibiotics immediately. Total of 55 patients who have been treated and followed due to multiple myeloma (MM) at Inönü University Turgut Özal Medicine Center Adult Hematology Bone Marrow Transplantation Unit between 2010 and 2014 years were enrolled to the study. At this study, we retrospectively evaluated 48 FEN episodes. Totally 3 patients engraftment durations could not be reported. Many parameters such as demographical characteristics, follow-up and neutropenia durations, nasocomial infection rates, prophylaxy rates ,rates of usage of antifungal, glycopeptide antibiotics and antiviral drugs, modification reasons, culture positivity, comorbidity and exitus reasons are evaluated. Of all FEN episodes, 39.5% were microbiologically defined infections (MDIs), 8.3% were clinically defined infections (CDIs) and 52.2% were fever of unknown origin (FUO). Bacterial microorganisms were isolated at 27 of 48 FEN episodes (87%) wheras 4 episodes were fungal microorganisms(13%). Isolated pathogen bacteria were gramnegative at 55.5% of the cases(15 episodes) and 44.5% gram-positive (12 episodes). Among isolated bacterial agents from total cultures, the most frequent gram-positive agent is coagulase negative staphylococcus (CNS) and the most frequent gram-negative agent is K.Pneumonia. Percentages of pathogens isolated from blood cultures are; 37.5% CNS(3 episodes), 12.5 % K.pneumonia (1 episode),%12.5 enterobacter(1 episode) ,% 12,5 Candida spp.(1 episode) and %25 ESBL positive E.coli(2 episodes). Percentages of pathogens isolated from cathater cultures are; 44.4% CNS(8 episodes), 11.3% P.aeruginosa (2 episodes), 5.5% K.pneumonia (1 episode ), 5.5% Acinetobacter baumannii (1 episode ), 5.5% E.coli (1 episode ), 5.5% ESBL positive E.coli (1 episode ), 5.5% Candida spp. (1 episode ), 11.3% Enterococcus spp. and 5.5% Staphylococcus homunis (1 episode). Leukocyte and thrombocyte engraftment days of 55 autologous bone marrow transplanted multiple myeloma patients were studied.Mean leukocyte engraftment duration of 23 patients with FEN episodes is 10.9 days whereas 9.8 days for 29 patients with no FEN episodes. Mean leukocyte engraftment duration of 52 patient is 10.3 days. Mean thrombocyte engraftment days of 23 patients with FEN episodes is 14.9 days whereas 12.1 days of patients with no FEN episodes. Mean thrombocyte engraftment duration of 52 patient is 13.3 days. Conclusively, close followup of infectious agents and accordingly developing empirical antibiotic treatment policies for every center may lead to better management of febrile neutropenia. Besides, centers should consider that their pathogen profile may change in time and they should evaluate their status periodically.