Research article
Bacterial infection profiles in lung cancer patients with febrile neutropenia
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* Corresponding author: Jean-Philippe Lanoix lanoix.jean-philippe@chu-amiens.fr
1 Department of Infectious Diseases, Amiens University Medical Center, Place Victor Pauchet, F-80000 Amiens, France
2 Department of Pneumology, Tourcoing Medical Center, 135 rue Pres Coty, F-59200 Tourcoing, France
3 Department of Infectious Diseases, Tenon Hospital, 4 rue de Chine, F-75020 Paris, France
4 Department of Pneumology, Saint-Quentin Medical Center, 1 avenue Michel de l'hospital, F-02100 Saint-Quentin, France
5 Department of Pneumology, Chauny Medical Center, 94 rue des Anciens combattants, F-02300 Chauny, France
6 Department of Pneumology, Amiens University Medical Center, avenue Laennec, F-80000 Amiens, France
BMC Infectious Diseases 2011, 11:183 doi:10.1186/1471-2334-11-183
Published: 27 June 2011Abstract
Background
The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.
Methods
We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm3) and fever (temperature > 38.3°C).
Results
The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. Staphylococcus species (mainly S. aureus) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm3.
Conclusion
Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.