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Clinical Manifestations of Febrile Neutropenic Patients with Solid Tumorand Risk Factors for Gram Positive Bacteremia
Nam Su Ku, M.D.1, Joon Hyung Kim, M.D.1, Yoo Kyoung Choi, M.D.1, Se Jin Jung, M.D.1Hyung Joong Oh, M.D.1, Ki Tae Yoon, M.D.1, Yeon-A Kim, M.D.1,2, So Youn Shin, M.D.1,2Myung Soo Kim, M.D.1,2, Young Keun Kim, M.D.1,2, Yoon Seon Park, M.D.1,2, Jun Yong Ch
1Department of Internal Medicine and 2AIDS Research Institue, 3Laboratory Medicine Yonsei University College of Medicine, Seoul, Korea
Vol.38 Num.5 (p250~258)
Backgrounds:Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor.
Materials and Methods:We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul.
Results:We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor.
Conclusions:Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.
Keywords : Solid tumor, Febrile neutropenia, Gram positive bacteremia, Clinical manifestations, Risk factors