Hematolojik maligniteli febril nötropenik hastalarda enfeksiyon etkenleri ve antimikrobiyal tedavilerin retrospektif ve prospektif olarak irdelenmesi

In this study, we aimed to evaluate the infections and the antimicrobial treatment in febrile neutropenic patients with hematologic malignancies examined between October 2005-October 2008. Three hundred and thirty five febrile neutropenic patients were evaluated.The etiology of fever was undetected in 24.1% patients; the infection was clinically documented in 20%, and microbiologically documented in 55.9%. Of the pathogens, Gram positive microorganisms were the most frequent ones (27.8%). The rate of Gram negative microorganisms was 25.1% and the rate of fungi was 18.2%. The prevalence of bacteremia was 27.4%. Gram-negative microorganisms were the most frequently isolated microorganism in bacteremia (47.8 %).The episodes in which cefepime, cefoperazone/sulbactam and piperacillin/tazobactam were given with or without amicasin as empirical treatment were included in the analysis. Out of the episodes, 43 received monotherapy and 280 received combination therapy. Total response rates of initial empirical antibacterial therapy; cefepime plus amicasin was 91%, piperacillin/tazobactam plus amicasin was 89.2% and piperacillin/tazobactam monotherapy was 80.6 %.The average time for the onset of antifungal treatment for all antifungals was 7.0 ± 4.6 day. Classical amphotericin B(36.8%), Liposomal amphotericin B(9.6%), Caspofungin(38.2%) and Voriconazole(17.6 %) were used in the antifungal treatment. The mean time the fever taken under control with antifungal therapy modification was 4.4 ± 5.1 days. Antifungal treatments evaluated in terms of mortality were not significant.The results of our study will contribute to the establishment of a definite treatment protocol in the coming years and to early identification of infections in this patient group. The data obtained will shed light on the most appropriate ways for the follow-up and treatment of patients.