Risk Factors and Attributable Mortality Associated with Superinfections in Neutropenic Patients with Cancer

Abstract

To identify the risk factors and attributable mortality associated with superinfections in febrile neutropenic patients with hematologic malignancies, we prospectively evaluated 333 episodes of fever and neutropenia by means of univariate and multivariate analyses. Superinfection was defined as any infection either occurring during antibiotic therapy or developing within 1 week after discontinuation of antibiotic therapy. Of 333 episodes, 46 (13.8%) were defined as superinfection; these episodes occurred in 46 patients. The risk factors for superinfection in the multivariate analysis were longer duration of profound neutropenia (P < .0001), lack of use of quinolones as prophylaxis (P < .0001), presence of a central venous catheter (P = .02), and persistence of fever after 3 days of antibiotic therapy (P = .02). The crude mortality rate among patients with superinfection was 48%, and the attributable mortality rate was 24% (95% confidence interval, 3%-45%). Identifying risk factors for superinfections in neutropenic patients might allow clinical practices to reduce the negative impact of this complication.

Secondary Infections in Cancer Patients with Febrile Neutropenia

“…The duration of severe neutropenia (<100 neutrophils mm -3 ) was strongly associated with SIs in a study by Nucci et al [2]. Nevertheless, neutropenia (<500 neutrophils mm -3 ) and severe neutropenia were not associated with SIs in the present study.…”

“…The presence of a CVC was previously reported to be a marker of SIs [1,2]. CVCs may promote skin and soft tissue infections, and are associated with bacteremia, especially due to gram-positive pathogens [12,13].…”

“…Although various studies have reported these risk factors, SIs were considered in only a few [1][2][3][4][5][8][9][10][11]. The frequency of SIs in adults varies between 12% and 24%.…”

“…Nonetheless, all these developments are associated with longer periods of neutropenia, severe mucositis, and widespread use of antimicrobial therapy or prophylaxis, which probably lead to the emergence of drug-resistant microorganisms. Consequently, patients undergoing such treatment are prone to severe infections, and cancer patients can experience multiple infectious episodes during the same period of neutropenia [1,2]. Recently, consideration of the level of risk of severe infection in patients treated for febrile neutropenia has been strongly recommended.…”

“…Recently, consideration of the level of risk of severe infection in patients treated for febrile neutropenia has been strongly recommended. To date, several studies have sought to identify severe infection risk factors in febrile neutropenia patients, and mortality rates in febrile neutropenia patients have been reported; however, only a few studies examined the factors associated with the risk of secondary infections (SIs) [1][2][3][4][5].…”