Multiday corticosteroids in cancer chemotherapy delay the diagnosis of and antimicrobial administration for febrile neutropenia: a double-center retrospective study

Abstract

BackgroundMedical staff should promptly administer antimicrobials to patients with febrile neutropenia (FN) to decrease the mortality related to cancer chemotherapy. Corticosteroids, which are used in cancer chemotherapy, have a fever-suppressive effect. This effect could lead to a blunt fever response and any local signs of infection, especially in patients receiving multiday corticosteroid administration. The aim of this study was to determine whether multiday corticosteroid administration in cancer chemotherapy delays the diagnosis of and antimicrobial treatment for FN.MethodsWe conducted a double-center retrospective study in Japanese patients with FN. The patients were divided into two groups based on the corticosteroid administration method, i.e., whether administration was multiday or not. To evaluate the degree of masking on FN by corticosteroids, we assessed the correlation between body temperature variation and time of antimicrobial administration after the initiation of chemotherapy. Risk factors for delayed antimicrobial administration were identified by multiple logistic regression analysis.ResultsTwo hundred thirteen patients were analyzed. The median time required to body temperature reaching 37.5 °C and for antimicrobial administration was longer in the multiday group than in the non-multiday group, with 0.64 and 0.60 days (P = 0.002 and P < 0.001), respectively. Multiday corticosteroid use was identified as an independent risk factor for delayed antimicrobial administration (odds ratio = 3.94; 95% confidence interval = 1.80–8.62; P < 0.001).ConclusionsMultiday corticosteroid administration in cancer chemotherapy delayed the diagnosis of and antimicrobial administration for FN. Furthermore, it was the only risk factor for delayed antimicrobial administration. We could thus provide evidence that the diagnosis of and antimicrobial administration for FN in patients receiving multiday corticosteroid administration should not be based on body temperature variation alone.

Differential Diagnosis of Fever of Unknown Origin in Drug Reaction with Eosinophilia and Systemic Symptom (DRESS)

“…Corticosteroid also able to halt interleukin-1 transcription which is important to augment T-cell proliferation. 19 However, we know that DRESS's mortality and morbidity is caused by its systemic involvement. Fever is manifested in 90% cases and usually very high in DRESS (>38°C), while in tuberculous lymphadenitis, systemic manifestation is uncommon, and fever is reported in HIV coinfection as a lowgrade fever.…”

Frequency and Culture Sensitivity for Bacteremia During Febrile Neutropenia in Children with Acute Lymphoblastic Leukemia. Do Age and Gender Matter?

“…Trying the alternative options i.e., a delay in chemotherapy or reducing the dosages of chemotherapeutics leads to longer hospitalizations, increased health care costs, and higher mortality rate in cancer patients. 2 In the recent medical literature, bacteremia has been found in 16-25% of pediatric oncology patients who become febrile. 3 The bacteria responsible for bacteremia are from both categories of bacteria i.e., grampositives and gram-negatives.…”

Afebrile S. aureus bacteremia in two patients with hemophagocytic lymphohistiocytosis receiving emapalumab/dexamethasone/etoposide

“…Dexamethasone can suppress fever and cause bacteremia to be undetected at early stages. 11 Emapalumab and dexamethasone may synergize their immunosuppressive effect on lymphocytes. In a one-two punch to the immune system, emapalumab neutralization of IFN-γ reduces lymphocyte chemoattraction, 3 while dexamethasone induces lymphocyte apoptosis.…”