Neutropenic patients and their infectious complications at a University Hospital

Abstract

Objective The aim of this study was to analyze the characteristics and infectious complications of neutropenic patients in a referral hospital. MethodsA cross-sectional study was carried out between April and September 2008, which enrolled all neutropenic patients identified by daily blood counts in the Universidade Federal de Minas Gerais. Demographic data and information on infections were obtained from the Hospital Infection Control Committee. Statistical analysis was performed using the Statistical Package for Social Sciences. ResultsOne hundred and sixteen patients were followed up during 129 hospitalizations. The patients had a mean age of 48.7 years old. Sixty-four (55.2%) patients were male and 25 (21.6%) died during the follow-up. In 97 (75.2%) of the hospitalizations, patients had episodes of febrile neutropenia. Patients classified as low-risk had a mortality rate of 16.2% (n = 12) vs. 39.1% (n = 9) among high-risk patients (p-value = 0.02). The death rate of the patients who had been submitted to hematopoietic stem cell transplantation was 13.5% (n = 5) vs. 26.7% (n = 16) among patients not submitted to transplantation (p-value = 0.13). Of the 155 infections diagnosed, 45.5% were defined as clinically documented. The etiological agent most frequently isolated was Escherichia coli and the main topography reported was bloodstream infections. The most used antimicrobial agents were cefepime, vancomycin and fluconazole. Approximately 24% of patients evolved with impaired renal function during hospitalization. ConclusionMost reported infections in neutropenic patients were defined as clinically documented, which shows the importance of suspicion in patients without specific signs and symptoms for early diagnosis and the need for the classification of risk for timely interventions.

Neutrophil–macrophage cooperation and its impact on tissue repair

“…Their main role is to patrol the bloodstream and tissue such as the skin to limit microbial entry, and to clear other harmful reagents or debris from the site of injury. Neutropenic patients suffer from recurrent bacterial and fungal infections and are at high risk of infection‐induced mortality, highlighting the critical importance of this cell type …”

“…Neutropenic patients suffer from recurrent bacterial and fungal infections and are at high risk of infection-induced mortality, highlighting the critical importance of this cell type. 13 Neutrophils are recruited to damaged tissues in response to various signals, being themselves either chemoattractants or molecules leading to the release of chemoattractants. Early in the response, danger-associated molecular patterns, such as high-mobility group box 1 proteins, heat shock proteins and purine metabolites (adenosine triphosphate/mitochondrial DNA/uric acid), are causing neutrophil recruitment to the injured tissue.…”

Early bacterial and fungal infection in children receiving allogeneic stem cell transplantation for acute lymphoblastic leukemia in Argentina

“…However, almost all data regarding HSCT‐related infection risk come from high‐income countries with little data in low‐ or middle‐income countries. It is possible that the risk of infection is much higher in low‐ or middle‐income countries based upon multiple factors including malnutrition, co‐infections, comorbidities, and environmental conditions . Endemic and locally unique infections are also important to consider.…”

Povidone‐iodine lowers the incidence of catheter‐associated bloodstream infection

“…The use of central venous (CV) catheters is common when carrying out chemotherapy for children with cancer, but patients requiring chemotherapy are usually prone to infections, and the use of such catheters may result in catheter-associated bacterial and fungal infections that may become life-threatening. 1 The main risk factors associated with the development of catheterassociated infections include frequent manipulation of the CV catheter, longer duration of catheterization, double-lumen catheters, and neutropenia. 2,3 Trials conducted to reduce the incidence of such infections show that using chlorhexidine and povidone-iodine to disinfect the skin at the catheter insertion site does not significantly alter the frequency of catheterassociated bloodstream infection (CABSI).…”