Effect of Neutropenic Diet on Infection Rates in Cancer Patients With Neutropenia

Abstract

Introduction: Neutropenic diets are commonly prescribed to cancer patients with neutropenia with the intention of reducing rates of infection. These diets are restrictive and are associated with lower patient satisfaction and possibly malnutrition. Further, it is unclear if these restrictive diets are effective in reducing infection. We performed a meta-analysis on the rates of infection reported in trials comparing the neutropenic diet to unrestricted diets in cancer patients with neutropenia. Methods and Materials: A comprehensive database search for all published randomized controlled trials comparing infection rates in cancer patients receiving a neutropenic diet versus an unrestricted diet was performed for all publications in English language from database’s inception until September 12, 2017. The search strategy, study selection, and subsequent analysis adhered to PRISMA guidelines. Random effects modeling was used to obtain pooled relative risks. The primary outcome measure was the rate of infection. Results: Five randomized controlled trials with a total of 388 patients were included in the final analysis. Patients mostly had acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or sarcoma. Infection was noted in 53.7% patients in the neutropenic diet group, as compared with 50% in the unrestricted diet group. No significant difference in infection rate was observed between the neutropenic diet versus unrestricted diet groups, pooled risk ratio (RR) 1.13 (95% CI, 0.98-1.30; P=0.10). Conclusions: This meta-analysis of randomized controlled trials suggests that the use of neutropenic diet was not associated with decreased risk of infection in neutropenic cancer patients. The continued use of neutropenic diets should be questioned.

Campylobacter fetus bacteremia and meningitis in an acute lymphoblastic leukemia patient undergoing maintenance therapy: a case report

“…In previous studies, a neutropenic diet has referred to a low bacterial diet, and neutropenic patients have been instructed to avoid mainly fresh fruits or vegetables [ 12 , 13 ]. A recent study showed that a neutropenic diet was not associated with a reduced risk of infection in neutropenic patients [ 14 ]; therefore, we did not instruct the patient to adhere to a neutropenic diet. However, safe food handling [ 15 ] may have been insufficient, and the entry of C. fetus was due to lack of instruction to the patient.…”

“…The lowest MICs were obtained with imipenem and meropenem. Cefotaxime is not an appropriate antimicrobial for C. fetus infection, since lower bactericidal activities in vitro were reported than those of ampicillin, gentamicin, and imipenem [ 14 ]. In accordance with this and E-test results, we switched from ceftriaxone to meropenem and continued the treatment for 3 weeks.…”

Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement

“…To date, the use of a restrictive neutropenic diet has not proven to be superior to regular diets with respect to safe food handling [ 29 , 34 , 35 , 36 , 37 , 38 ]. It is now clear that restrictive diets have little scientific support and represent an unnecessary burden for the patients and the family, with the risk of further inadequate food intake.…”

Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute

“…The KRINKO is strongly opposed to a strict “neutropenic diet”, as the benefits are unproven and such a diet can significantly reduce the patient’s quality of life [ 7 ], [ 77 ], [ 169 ], [ 170 ], [ 171 ], [ 172 ], [ 173 ], [ 174 ], [ 175 ], [ 176 ], [ 177 ], [ 178 ] (cat. II).…”