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Background Children with acute lymphoblastic leukemia (ALL), especially those with febrile neutropenia, are susceptible to sepsis. Several factors have been associated with the occurrence of sepsis in children with leukemia. Objective To identify potential risk factors associated with sepsis in children with ALL and febrile neutropenia. Methods This cross-sectional study was done in children with ALL who sought treatment at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from January 2019 to March 2022. We recorded patients’ gender, age, nutritional status, absolute neutrophil count (ANC), co-infection, prophylactic antibiotic use, and phase of chemotherapy. Results Of 131 subjects, 57.3% were male and 42.8% were wasted. Subjects had a median age of six years old and median ANC of 230 cells/mm3. Furthermore, 48.9% of subjects had co-infections, 87.8% had not received prophylactic antibiotics, and 48.9% were in the induction phase of chemotherapy. Multiple logistic regression analysis revealed that older age [OR 1.16 (95%CI 1.04 to 1.29); ?=0.149; P=0.008] and co-infection [OR 12.9 (95%CI 5.01 to 33.21); ?=2.551; P

Abstract In contrast to transplant recipients, there is a paucity of data regarding frequency and clinical significance of viraemia in children receiving conventional chemotherapy. In a prospective observational study, we assessed the frequency of and clinical impact of viraemia with cytomegalovirus (CMV), Epstein-Barr virus (EBV), adenovirus, human herpesvirus-6 (HHV6) and herpes-simplex virus 1/2 (HSV1/2) in paediatric cancer patients at diagnosis, at a routine examination during intensive chemotherapy, and during febrile neutropenia (FN). Seventy-nine patients (median age 6 years; 66 children with haematological malignancies) were included in the study. Overall, 362 blood samples were analysed, 72 from the time at diagnosis (11.1% with positive PCR result), 118 during a regular control after chemotherapy (11.0% positive), and 159 during FN (8.8% positive). The overall positivity rate was 9.6% (CMV 3.3%, HHV6 2.7%, HSV 2.2%, EBV 0.8% and adenovirus 0.3%). There were no significant differences between FN episodes with and without viraemia in terms of duration of fever or neutropenia/lymphopenia, severity of mucositis (> II0), incidence of diarrhea and ICU admission. Our results indicate that viraemia in paediatric cancer patients generally does not have a major clinical impact, and may help in the decision regarding the indication of routine evaluation for viraemia in febrile neutropenic, but otherwise asymptomatic children.

Abstract Ramucirumab plus docetaxel (RD) can cause febrile neutropenia (FN), which frequently requires the prophylactic administration of pegfilgrastim. However, the effects of prophylactic pegfilgrastim on FN prevention, therapeutic efficacy, and prognosis after RD have not been fully evaluated in patients with advanced non-small-cell lung cancer (NSCLC). Two hundred and eighty-eight patients with advanced NSCLC who received RD as second-line therapy after platinum-based chemotherapy plus PD-1 blockade were included. Patients were divided into groups with and without prophylactic pegfilgrastim, and adverse events, efficacy, and prognosis were compared between both groups. Of the 288 patients, 247 received prophylactic pegfilgrastim and 41 did not. The frequency of grade 3/4 neutropenia was 62 patients (25.1%) in the pegfilgrastim group and 28 (68.3%) in the control group (p

Objective. The DoTT (Decreasing Time to Therapy) project aimed to minimize the interval between fever onset and medical interventions for children with febrile neutropenia. The objective of this study was to determine the effect of implementing the DoTT project on the hospital time to antibiotic (TTA) and patient time to arrival (PTA) at the hospital in children with febrile neutropenia admitted to the emergency department. Methods. The DoTT project was implemented at a Peruvian hospital and followed the World Health Organization (WHO) multimodal improvement strategy model. Components included creating a healthcare delivery bundle and antibiotic selection pathways, training users of the bundle and pathways, monitoring patient outcomes and obtaining user feedback, encouraging use of the new system, and promoting the integration of DoTT into the institutional culture. Emergency room providers were trained in the care delivery for children with cancer and fever and taught to use the bundle and pathways. DoTT was promoted via pamphlets and posters, with a view to institutionalizing the concept and disseminating it to other hospital services. Results. Admission data for 129 eligible patients in our registry were analyzed. The TTA and PTA were compared before and after the DoTT intervention. The median TTA was 146 minutes (interquartile range [IQR] 97–265 minutes) before the intervention in 99 patients, and 69 minutes (IQR 50–120 minutes) afterwards in 30 patients (p < 0.01). The median PTA was reduced from 1 483 minutes at baseline to 660 minutes after the intervention (p < 0.01). Conclusions. Applying the WHO multimodal improvement strategy model to the care of children with febrile neutropenia arriving at the hospital had a positive impact on the PTA and TTA, thus potentially increasing the survival of these patients.

ABSTRACT Objective To assess the incidence of febrile neutropenia without primary granulocyte colony-stimulating factor prophylaxis in patients undergoing chemotherapy with adjuvant docetaxel and cyclophosphamide, and to evaluate the toxicity profile of brand-name docetaxel (Taxotere ® ) and the generic formulation. Methods This retrospective study was conducted using data obtained from electronic medical records of patients treated at a Brazilian cancer center. Patients with breast cancer who underwent adjuvant treatment between January 2016 and June 2019 were selected. Data were analyzed using chi-square and Fisher correlation of variables, and multivariate analyses were adjusted for propensity score. Results A total of 231 patients with a mean age of 55.9 years at the time of treatment were included in the study. The majority (93.9%) had luminal histology, 84.8% were at clinical stage I, and 98.2% had a good performance status. The overall incidence of febrile neutropenia in the study population was 13.4% (31 cases). The use of brand-name docetaxel (Taxotere ® ) was the only factor associated with febrile neutropenia occurrence (OR= 3.55, 95%CI= 1.58-7.94, p=0.002). Conclusion In patients with breast cancer who require treatment with adjuvant docetaxel and cyclophosphamide regimen, the toxicity profile differs between brand-name and generic docetaxel. Regardless of the formulation used, the incidence of febrile neutropenia was less than 20%, which may allow for the omission of primary prophylactic granulocyte colony-stimulating factor use in this setting.

Background. Despite promising results of autologous bone marrow transplantation (BMT) in patients with lymphoma, infectious complications limit its positive outcomes. This study evaluated the incidence and associated factors of the occurrence of febrile neutropenia (FN) following BMT in patients with lymphoma. Material and methods. Overall, 147 lymphoma patients who were candidates for BMT were consecutively included. Clinical and laboratory results were recorded, and after BMT, the occurrence of FN was investigated through the daily evaluation of neutrophil count and body temperature. Results. FN occurred in 91 patients (61.9 %) on average after 12.77 ± 2.45 days after BMT. Lower fluid balance was associated with a higher risk of FN (lowest adjusted odds ratio [OR] at day -2 = 0.602, 95% confidence interval [CI] = 0.299 – 0.870, p value = 0.007). The higher uric acid level was associated with a higher risk of FN (highest adjusted OR at day -10 = 1.617, 95% CI = 1.328 – 1.963, p value = 0.035). LDH also had a positive relationship with FN (highest adjusted OR at day 0 = 1.501, 95% CI = 1.198 – 2.104, p value = 0.004). Conclusion. Adequate hydration of the patients is of paramount importance for preventing FN in patients who receive BMT. Furthermore, uric acid and LDH could be considered in future studies for risk stratification of FN.

Febrile neutropenia (FN) is a well-known complication of chemotherapy (CHT) regimens, which appears more frequently in patients receiving CHT for hematologic malignancies, than those with solid tumors. Given the fact that this condition is life threatening, as well as multiple complications that may happen, rapid intervention is required, administration of empirical antibiotic therapy being necessary in the first hour of admission. Due to the high mortality rate associated with Pseudomonas aeruginosa infections, patients at risk should be given an antipseudomonal antibiotic agent, such as cefepime, carbapenem or piperacillin-tazobactam. Regarding empirical antibiotic coverage for gram-positive microorganisms, this is preserved for hypotensive patients, with skin/soft infections or suspected catheters infection or those taking fluoroquinolone. Considering the fact that a variety of bacterial, viral and fungal pathogens are responsible for high morbidity and mortality among patients with FN, preventable measures like antibiotic, antifungal and antiviral, as well as vaccination and prophylaxis with G-CSF, are crucial components in providing medical treatment for onco-hematological patients.

An increase in the number and the complexity of cardiac surgery has brought on a rise in the proportion of healthcare-associated Infectious Endocarditis (IE), and as a result, today S. aureus is the most common causative pathogen for this condition. Clinical suspicion for IE should be raised in front of a patient with predisposing risk factors, a new heart murmur and/or vasculitic/embolic events. The Duke Criteria have been long used to diagnose IE. However, they underwent several changes in order to improve their sensitivity in the diagnosis of Q-fever IE and to decrease the size of the possible IE group. Our primary goal is to enhance the knowledge regarding the diagnosis and treatment of infective endocarditis. In acute IE, prior to beginning antibiotic therapy, at least three sets of blood cultures must be taken, ideally from three distinct sites, as determining the etiologic agent is of highest importance. The diagnosis of IE cannot be made based just on a single positive blood culture. To diagnose subacute IE, three to five sets of blood cultures must be drawn over the course of 24 hours. Transthoracic echocardiography (TTE) remains the preferred investigation when the diagnosis of IE is suspected. Transoesophageal echocardiography (TOE) is recommended when TTE is unremarkable but the suspicion is still high. A whole-body CT scan, an MRI, a cardiac CT, PET-CT, or radiolabelled leucocyte single-photon emission computed tomography may be helpful when TTE and TOE are inconclusive. Recommended empirical therapy for Native Valve Endocarditis (NVE) and late Prosthetic Valve Endocarditis (PVE) consists of IV Amoxicillin, Oxacillin and Gentamicin administered until blood culture results are available. If a patient is allergic to penicillin, IV Vancomycin and Gentamicin should be given. The recommended empirical antibiotic regimen for early PVE includes IV Vancomycin, Gentamicin, and Rifampin. Once the results of blood cultures are available, the treatment will depend on the isolated organism, its sensitivity to antibiotics, and whether it is an NVE or a PVE.

ABSTRACT Objective: The aim of this study is to analyze the clinical utility and cost of the respiratory virus panel test in the febrile neutropenia (FN) episode in children undergoing chemotherapy. Material and Method: From 2014 to 2018, 180 episodes of FN in 93 children with cancer were retrospectively analyzed. The patients were divided into those with (Group A) and without respiratory virus panel (Group B). The demographic and clinical features and cost analysis of the groups A and B were noted. Results: Of these FN episodes, 46 were in Group A (25.5%) and 134 were in Group B (74.5%). We found positivity in 45 (97.8%) of 46 episodes in Group A. While modification was required in 14 FN episodes (30.4%) in Group A, modification was required in 35 FN episodes (26.1%) in group B. The difference was not statistically significant (p=0.570). In Group A, only 5 (10.8%) were modified according to the respiratory virus panel. The respiratory virus panel prices were $72.43 (interquartile range, $38.8). The ratio of respiratory virus panel cost to the total cost was 9.67% (interquartile range 11.6). The median total cost of group A was $663.18 (interquartile range, 850.1), while that of group B was $596.24 (interquartile range, 723.81). The difference was not statistically significant (p=0.141). Conclusion: The respiratory virus panel may contribute to the preference of antibiotics by giving rapid results in FN attacks. However, no effect on modification rates was observed, and only a small percentage of patients underwent antibiotic modification according to respiratory virus panel.

Introduction Febrile neutropenia (FN) is one of the major complications with high mortality rates in cancer patients undergoing chemotherapy. The Multinational Association for Supportive Care in Cancer (MASCC) risk-index score has limited applicability for routine use in the emergency department (ED). This study aimed to develop simplified new nomograms that can predict 28-day mortality and the development of serious medical complications in patients with FN by using a combination of complete blood count (CBC) parameters with quick Sequential Organ Failure Assessment (qSOFA). Methods In this retrospective observational study, various models comprising qSOFA score and individual CBC parameters (red cell distribution width, delta neutrophil index, mean platelet volume (MPV)) were evaluated for association with outcomes by a multivariate logistic analysis. Subsequently, nomograms were developed for outcome prediction. The primary outcome was mortality at 28 days from ED presentation; the secondary outcome was the development of serious medical complications. Results A total of 378 patients were included. Among the CBC parameters, only MPV was significantly associated with 28-day mortality and serious medical complications in patients with FN. The nomogram developed to predict 28-day mortality and serious medical complications showed good discrimination with area under the receiver-operating characteristic curve (AUC) values of 0.729 and 0.862 (95% CI, 0.780–0.943), respectively, which were not different from those of the MASCC score (0.814, 95% CI, 0.705–0.922; p = .07 and 0.921, 95% CI, 0.863–0.979; p = .11, respectively) in the validation set. The calibration of both nomograms demonstrated good agreement in the validation set. Conclusion In this study, a novel prognostic nomogram using qSOFA score and MPV to identify cancer patients with FN with high risk of 28-day mortality and serious medical complications was verified and validated. Prompt management of fatal complications of FN can be possible through early prediction of poor outcomes with these new nomograms.KEY MESSAGES Among the evaluated CBC parameters, only mean platelet volume was associated with 28-day mortality and serious medical complications in cancer patients with febrile neutropenia. A novel and rapid prognostic nomogram was developed using quick Sequential Organ Failure Assessment score and mean platelet volume to identify cancer patients with febrile neutropenia having high risk of 28-day mortality and serious medical complications. The nomogram developed to predict 28-day mortality and serious medical complications in patients with febrile neutropenia showed good discrimination and provides rapid patient evaluation that is especially applicable in the emergency department.

Bone marrow recipients are the most immunocompromizied patients who are susceptible to multiple infections. It is especially true for long-term episodes of drug-associated granulocytopenia. Our research goal was to identify risk factors of healthcare-associated infections (HAIs) in patients after bone marrow transplantation (BMT). Risk factors of developing HAIs were identified by accomplishing an analytical epidemiological “case – control” study with 973 patients participating in it. They all underwent BMT in the Hematology, Chemotherapy and Bone Marrow Transplantation Department of the Pirogov National Medical and Surgical Center on a period from 2015 to 2018. The following diseases were diagnosed in them: lymphoma (n = 158), multiple myeloma (n = 96), and multiple sclerosis (n = 719). HAIs cases were selected based on the standard (epidemiological) case definition in accordance with the Federal Clinical Recommendations on Epidemiological Surveillance over HAIs approved by the National Association of Experts responsible for Control over Healthcare-Associated Infections. Retrospective analysis established 75 HAIs cases or 7.7 % of the total number of the analyzed patients after BMT. Catheter-related bloodstream infections took the leading place among all the HAIs accounting for 52.0 ± 2.4 %. They were followed by bloodstream infections, 28.0 ± 3.1 %; lower respiratory tracts infections, 17.0 ± 3.2 %; and post-injection complications, 3.0 ± 0.6 %. Oncological diseases were established to cause HAIs in bone marrow recipients more frequently (ОR = 5.603; 95 % CI = 3.422÷9.174) than multiple sclerosis (ОR = 0.178; 95 % CI = 0.109÷0.292). This indicates that an underlying disease has its influence on a risk of infectious complications. We established a direct correlation between HAIs frequency and contamination with opportunistic microorganisms detected in objects in the hospital environment (r = 0.79, p = 0.01). This calls for implementing up-to-date disinfection provided for such objects.

Objective: To assess whether procalcitonin (PCT) levels can be a reliable indicator of when it is unnecessary to step up antibiotics in children with cancer and fever without source (FWS). Material and Methods: The medical records of children with hematologic-oncologic malignancies aged 3 months-15 years who had FWS ≥4 days and were admitted to Songklanagarind Hospital from December 2016 to February 2019 were reviewed. Results: FWS was identified in 89 patients. PCT levels were tested in 43 patients; 21 and 22 patients had low PCT (PCT

Febrile neutropenia is a serious chemotherapy-related adverse event that can lead to complications and death and it could be a significant burden on the organization of the health care system. The risk for febrile neutropenia is determined by chemotherapy-induced myelosuppression and the presence of patient-related risk factors. In the literature, various patient-related risk factors are taken into consideration. It was suggested that the patient age is the one of the most important ones. If the estimated risk for the febrile neutropenia is high, prophylactic use of myeloid growth factors (granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor) is recommended. In patients with solid tumors and lymphomas it was shown that the prophylactic use of myeloid growth factors significantly reduces the incidence of febrile neutropenia, early mortality during chemotherapy and infection-induced mortality. In patients who develop febrile neutropenia, there is less evidence for the therapeutic use of myeloid growth factors compared to prophylactic use, although there is a clear benefit in reducing the time to neutrophil count recovery. There is a clear benefit for hospitalized patients, also, in reducing duration of hospitalization. In patients with febrile neutropenia who have not been previously treated with prophylactic myeloid factors, assessment of risk factors for the complications is advised. In patients with high-risk febrile neutropenia therapeutic use of growth should be considered.

Background: Colorectal cancer (CRC) is the fourth most common cause of death diagnosed in both men and women. Though there are modifiable and non-modifiable risk factors for CRC. cancer patients encounter chemotherapy-associated drug interactions and adverse drug reactions hence the need for such a study will help the professionals to improve the patient’s quality of life. Materials and Methods: A six-month retrospective study of 130 patients who satisfied the inclusion and exclusion criteria was conducted by collecting data from November 2020 to May 2021. Data was collected from the Mediware system of the hospital using specially designed data collection forms. Results: Out of 130 patients, 61.51% were male and most of the patients were more than 60 years old. In this study, 11 patients had a history of smoking and alcoholism and 4% had a family history of CRC. Comorbidities associated with CRC were HTN and DM. In the study, stage 4 cancer patients were found to be more. 77.69% of patients had received chemotherapy along with surgery, and the most commonly prescribed regimen was Capcetabine and OxaliplatinThe length of hospital stay was increased for the FOLFOX (Oxaliplatin, 5-Fluorouracil, and Leucovorin) regimen. The common ADR analyzed was constipation, followed by vomiting and neutropenia, and most ADRs were associated with the CAPOX regimen (diarrhea) and treated accordingly.10 patients had febrile neutropenia, 5 patients had grade 4 neutropenia and all were treated with antibiotics and filgrastim. Febrile neutropenia was seen in patients with metastasis. Conclusion: Timely and appropriate treatment for ADRs and early screening can improve the quality of life of individuals. Further studies on this topic will help to improve the treatment quality provided by professionals

Febrile neutropenia is a serious adverse effect of chemotherapy. It can lead to complications and death, as well as delays in treatment, chemotherapy dose reductions, compromised treatment efficacy, and reduced survival. The assessment of the patient-related risk factors plays a significant role in the prevention of febrile neutropenia and its complications. In the case of intermediate-risk chemotherapy, the patient-related factors contribute to the estimation of an overall febrile neutropenia risk as well as to timely planning of primary prophylaxis using growth factors. Patients presenting with febrile neutropenia undergo a detailed initial risk assessment for serious complications so that an appropriate treatment can be selected. Recommendations given by the guidelines outline the classification of and risk factors for febrile neutropenia complications. The use of patient-related factors and validated tools for the risk assessment of complications makes it possible to optimize the treatment for each patient and to reduce the risk of morbidity and mortality due to febrile neutropenia.

Background Post-chemotherapy febrile neutropenia results in high morbidity and mortality in children with malignancy. Many prognostic factors, such as microorganism patterns, as well as the use of antibiotics and antifungals can affect the outcomes. However, limited study is available in Indonesia. Objective To determine the microbial profiles, antibiotic sensitivity, and other factors that influence mortality from febrile neutropenia in pediatric malignancies with infections. Methods This retrospective cohort and descriptive study of 180 children with 252 episodes of neutropenic fever was done in Cipto Mangunkusumo Hospital, Jakarta, between 2015 and 2017. Medical history of possible predictive prognostic factors, including microorganism patterns and antibiotic sensitivity, were recorded. Prognostic factors were analyzed using multivariate logistic regression tests. Results The most common bacteria was Gram-negative (54.5%), while Candida sp. was the most common fungal infection (82.5%). Klebsiella sp. was mainly sensitive to amikacin (85.71%), while Pseudomonas aeruginosa was sensitive to ceftazidime (75%), as well as amikacin and gentamicin (100% sensitivity in combination). Staphylococcus sp. was mainly sensitive to amoxi-clav and ampi-sulbactam (76.9%). Almost all fungal groups were susceptible to fluconazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increased mortality risk were central venous cannulation (RR 1.947; 95%CI 1.114 to 3.402), wasting (RR 1.176; 95%CI 1.044 to 1.325), severe wasting (RR 1.241; 95%CI 0.975 to 1.579), and hematologic malignancies (RR 0.87; 95%CI 0.788 to 0.976). Conclusion Central venous cannulation and wasting are significant prognostic factors of increased mortality in children with febrile neutropenia. Gram negative bacteria along with Candida sp. is the most common pathogen in such condition.

Background/Aims Febrile neutropenia (FN) interferes with the proper chemotherapy dose density or intensity in non-Hodgkin’s lymphoma (NHL) patients. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) ± rituximab has an intermediate FN risk. Prophylactic granulocyte colony-stimulating factor (G-CSF) support is recommended for patients with other host-related risk factors. Methods We evaluated the risk factors for FN-related admission in NHL patients who have received primary G-CSF (lenograstim) prophylaxis. Results Data from 148 patients were analyzed. The incidence of neutropenic fever was 96 events (12.2%), and the median period was 3.85 days (range, 0 to 5.9); the median duration of neutropenia was 4.21 days (range, 3.3 to 5.07). Eighty-three FN-related admissions were reported. Advanced age (> 60 years), female sex, a low albumin level, and prednisone use were associated with FN-related admission in multivariable analysis (p = 0.010, p < 0.001, and p = 0.010, respectively). A comparison between diffuse large B-cell lymphoma patients treated with R-CHOP and pegylated G-CSF and those treated with R-CHOP and lenograstim did not reveal significant differences in the FN-related admission rate between the two groups, although the lenograstim-treated group had a higher incidence of severe neutropenia. Conclusions Elderly patients, female patients, and patients with low albumin levels need to be actively followed-up for FN even when primary prophylaxis with G-CSF has been used.

Objective: To study organisms causing bacteremia and their outcome in cancer children with febrile neutropenia (FN) admitted at our centre. Study Design: Retrospective longitudinal study. Place and duration of study: Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, from Feb to Dec 2017. Methodology: All pediatric oncology patients with febrile neutropenia admitted to the inpatient department were included. Data fields included age, diagnoses, demographics, organism types, time to positivity, multi-drug resistance, antibiotics, and outcome. Results: A total of 391 episodes of febrile neutropenia were documented among 86 patients. The mean age was 4.7±2.7 years. Twelve (14.0%) patients had intensive care admission, and 9(10.5%) of them died. Fifty-four (63.0%) children had primary diagnoses of haematological malignancies. Sixty-five percent had mucositis, central catheter, or both as risk factors. Thirty-nine isolates were cultured in 391 febrile-neutropenic episodes. Escherichia coli was the most frequently isolated organism in 16(41.0%) cultures, followed by Pseudomonas and Streptococcus pneumoniae in 4(10.3%) each. Poly-microbial isolates were seen in 6(15.4%) cultures. Multi-drug resistance was found in 12(30.8%) isolates. Thirty-four (87.0%) patients with positive cultures received appropriate antibiotics. Majority organisms were sensitive to Piperacillin/Tazobactam (14,35.9%) followed by Meropenem (10, 25.6%) and Colistin (6, 15.4%). Conclusions: Rapid identification of organisms from positive blood cultures combined with antimicrobial stewardship can have improved antibiotic treatment and outcomes.

Introduction: Pegfilgrastim is indicated in patients receiving myelosuppressive anticancer drugs to reduce the Duration of Severe Neutropenia (DSN) and incidence of Febrile Neutropenia (FN). The efficacy and safety of a proposed Pegfilgrastim biosimilar should be compared with an approved biologic drug to establish therapeutic equivalence. Aim: To compare the efficacy of Lupin’s biosimilar Pegfilgrastim versus Neulastim® (Amgen Inc.) as an adjunct to chemotherapy in patients with non-myeloid malignancies. Materials and Methods: The present prospective, open-label, randomised phase lll clinical study was conducted on a total of 170 patients with histologically or cytologically confirmed non-myeloid malignancies eligible to receive a myelosuppressive chemotherapy regimen. The participants were administered Lupin’s Pegfilgrastim (n=86) or Neulastim® (n=84) 6 mg by subcutaneous injection, once in each chemotherapy cycle for a maximum of three cycles. Patients were chemotherapy naive or had not received myelosuppressive chemotherapy within last 12 months of screening. The primary efficacy endpoint was DSN (number of days on which absolute neutrophil count

Introduction: Febrile neutropenia is one of the most common presentations to the emergency department. Identification and empirical antibiotic therapy improve the outcome of these patients. The objectives of the study are to collect prospective data on febrile neutropenic patients and describe their clinical profile. Materials and Methods: The study was conducted at the Emergency Department, Christian Medical College and Hospital, Vellore, from July 2017 to February 2018. After obtaining informed consent, all adult patients who presented with fever and neutropenia were included in the study. Results: Of 3778 patients with fever, 101 patients had febrile neutropenia and were included in the study. Males comprised 55.5%. Moderate neutropenia was seen in 30 patients and severe neutropenia was seen in 71 patients. Among the various comorbidities, diabetic patients were more at risk of developing febrile neutropenia (17. 82%). The common organisms isolated were Gram-negative organisms (62. 5%). Coagulase-negative staphylococci and Escherichia coli were the most common organisms. Aplastic anemia was the main diagnosis among those patients with febrile neutropenia (43.76%). The mortality of the febrile neutropenic patients was 1.98%. Overall survival was 96.04%. Conclusion: Empirical antibiotic therapy covering the most common organisms should be started early in febrile neutropenia patients.

Abstract Although the incidence of hematological toxicity due to Trifluridine/tipiracil (FTD/TPI) treatment is high, the incidence of severe adverse events has been reported to be relatively low. However, it should be noted that patients with renal impairment are prone to severe hematological adverse events.

Bacteremia in the febrile neutropenic patients significantly increases the mortality. It takes a long time to complete the blood culture for the diagnosis of bacteremia. Therefore, quick and specific markers are needed for the prediction of bacteremia. The purpose of this study are to compare the diagnostic value of lactate, procalcitonin, C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1) levels in a patient with febrile neutropenia, and to evaluate its usefulness in predicting bacteremia. This study was designed to be prospective case-control study. Forty-eight patients and forty control cases aged 18 years or older who were monitored between May 2016 and May 2017 were included in the study. P-value as

Adjuvant chemotherapy has been widely applied in patients with breast malignancy after surgery to prevent its recurrence and to improve survival comprehensively. Febrile neutropenia is one of the most life-threatening chemotherapy-associated toxicities. A 66 years old woman came to an emergency department of a secondary healthcare facility one week after her final chemotherapy with dose regimen of docetaxel and epirubicin, followed by having nausea, vomitus, and general fatigue with a fever of 38.2°C. Based on her medical record, she had experienced breast malignancy for almost two years and had already conducted mastectomy three months after her diagnosis. Her leukocyte number was only 300 cells per mm3, with 23% neutrophil, hypoalbuminemia, and hypokalaemia. She was then treated in an internal ward and was given intravenous ceftazidime, fluid, granulocyte colony-stimulating factor, albumin transfusion, intravenous potassium replacement, and symptomatic medication. After two days of inpatient care, she was referred to an oncology team in a tertiary healthcare facility. Febrile neutropenia is considered as a fever with a low neutrophil number as a result of bone marrow suppression. The neutrophil plays an essential role as the body’s first line of defence. This condition could make the patient more vulnerable to infections. The Patient was given broad-spectrum antibiotics and typically hospitalized to allow close monitoring until the neutropenia was resolved. Febrile neutropenia possesses a serious threat to patients with breast malignancy who are on cytotoxic chemotherapy. Urgent full blood count and immediate broad-spectrum antibiotic administration are significant to reduce morbidity and mortality.

Context Febrile neutropenia is a serious complication of chemotherapy affecting patients with both hematological and solid malignancies, respectively. To the best of our knowledge, there is paucity of literature from Uttarakhand, India on microbiological profile of blood stream infections (BSIs) in febrile neutropenic patients. Aims The study aims to generate preliminary data on microbiological profile and antibiotic resistance pattern of BSIs in febrile neutropenic patients. Settings and Design The design involved cross-sectional study from January 1, 2019 to July 31, 2019. Methods and Materials Data of nonrepetitive paired peripheral blood samples obtained from 306 consecutive febrile neutropenic cancer patients of all age groups and both sexes, for culture and sensitivity testing, were retrospectively analyzed. All blood samples were subjected to aerobic culture using BACT/ALERT three-dimensional microbial detection system. Growth obtained in culture was identified by conventional biochemical methods. Antibiotic susceptibility testing of bacterial isolates was performed using modified Kirby Bauer disk diffusion method. Statistical Analysis Used Fisher’s exact test was used for the analysis. Results Mean age ± SD of the study population was 32.39 ± 10.56 years with a male to female ratio of 1.55:1. 74.18% of the blood samples were received from patients suffering from hematological malignancies. Microbiologically confirmed BSIs were observed in 27.1% patients. Gram-negative bacilli were predominantly isolated in culture with Klebsiella spp. being the most common. Percentage resistance values of gram-negative bacilli to aminoglycosides, β-lactam/β-lactamase inhibitor combinations, fluoroquinolones, cephalosporins, carbapenems, chloramphenicol, ampicillin, co-trimoxazole, and doxycycline were 26.6 to 91.7%, 8.3 to 86.6%, 10 to 66.7%, 13.3 to 73.3%, 8.3 to 73.3%, 80 to 93.3%, 13.3 to 20%, 16.7 to 66.6%, and 13.3 to 16.7%, respectively. Conclusion Implementation of antimicrobial stewardship program along with hospital infection control practices is needed for preventing BSIs due to MDR organisms.

Aims and Objectives: The aim and objective of this study is to detect invasive fungal infections (IFIs) early and with more sensitivity by the nested polymerase chain reaction (PCR) for fungus as compared to fungal culture in clinically suspected patients and also explore its correlation in reference to age, duration of symptoms, immunocompromised status, and other risk factors predisposing to IFIs. Materials and Methods: In this cross-sectional study, 50 suspected patients admitted in medical acute care unit/intensive care unit (ACU/ICU) of Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India, comprised the study. All cases were selected based on the predefined inclusion and exclusion criteria. A detailed history, clinical examination, and all required investigations were done in all suspected patients. Blood samples were taken for nested-PCR for fungus and culture. Nested PCR was performed on extracted DNA form samples collected from all participants under the study. Results: Our study comprised of 50 suspected immunocompromised patients of IFIs. Among the participants under the study, the most common risk factor was diabetes mellitus (28% cases). Nearly two-thirds (60%) of the cases were 50 years or more. Around 70% of the cases had a history of illness more than 2 weeks. Nested PCR for fungus came out to be positive in 21/50 patients (42%); however, fungal culture was positive in none. Among the admitted patient in ACU/ICU, 75% were neutropenic. Conclusions: IFIs are more common in immunocompromised individuals, patients with comorbidities, long history of symptoms, and elderly population. Nested PCR for fungus has a high sensitivity (as compared to the fungal culture), and also they are rapid in giving the results. Thus, nested PCR for fungus can be used in a cost-effective manner for the early and reliable diagnosis of clinically suspected IFIs.

Introduction Fever during chemotherapy induced neutropenia is a common and potentially life-threatening complication of the treatment of childhood cancer. Predictions of poor outcome could be enhanced by incorporating serum biomarkers of inflammation at presentation and reassessment. Methods A prospective cohort study was conducted of children under 18 years old, being treated for cancer or a cancer-like condition, who presented with fever (≥ 38.0°C) and neutropenia (neutrophil count < 0.5*109/L). Clinical features were recorded, along with three experimental inflammatory biomarkers: procalcitonin (PCT), interleukin-6 (IL-6) and interleukin-8 (IL-8). Outcomes included serious medical complications (SMC): any infection related mortality, critical care and organ support, severe sepsis, septic shock, significant microbiologically defined infection, or radiologically confirmed pneumonia. Results Biomarker assessments were undertaken in 43 episodes of fever and neutropenia, from 31 patients aged between four months and 17 years old (median six years): 20 were female and 22 had acute leukaemia. Five episodes of SMC were noted. PCT, IL-6 and IL-8 had poor individual discriminatory ability (C-statistic 0.48 to 0.60) and did not add to the value of clinical risk stratification tools. Insufficient data were collected to formally assess the value of repeated assessments. Conclusions Incorporating serum biomarkers of inflammation at presentation of episodes of fever with neutropenia in childhood does not clearly improve risk stratification. The value of serial assessments requires further investigation.

Multimodal therapy, used for the treatment of patients with Hodgkin’s disease (HD), makes them prone to life-threatening infections, attributed mainly to febrile neutropenia. Herein, we present a case report of fatal combined bacterial and viral infection in a 49-year-old female patient, subject to polychemotherapy for HD. Rapid microbiological diagnosis performed by multiplex polymerase chain reaction elucidated the causes of the infection within hours. Listeria monocytogenes was detected in both the cerebrospinal fluid and blood samples. Nasopharyngeal swabs returned positive for two swine-derived strains of influenza A virus. We aimed to emphasize the importance of these pathogens and draw attention to their association in the aetiology of infections among patients receiving chemotherapy. In conclusion, better surveillance is needed to improve the early diagnosis of infectious complications in these patients.

Objective: This study aimed to identify the risk factors associated with mortality in febrile neutropenic patients. Methods: This 3-year, single center, retrospective, observational study was conducted at Chiangrai Prachanukroh Hospital, Chiangrai Province, Thailand. The inclusion criteria consisted of a patient age of over 15 years and a diagnosis of febrile neutropenia. Results: Most of the 303 febrile neutropenic inpatients had a Multinational Association for Supportive Care in Cancer (MASCC) risk score < 21. The median length of stay was 6 days (interquartile range: 4-11 days). During 30 days of admission, 24.8% of the patients succumbed. In a univariate analysis, patients receiving G-CSF, the post-chemotherapy-related group, patients with MASCC score > 16, and patients admitted in private had significantly higher survival rate. In a multivariate analysis, a MASCC score ≤ 16 and non-chemotherapy-related groups were associated with an increased mortality risk. Conclusion: The 30-day survival rate of febrile neutropenic patients in Thailand is seventy-five percent. Low MASCC score and non-chemotherapy-related neutropenia are associated with a higher risk of unfavorable outcomes.

Abstract Objective This study aimed at assessing the management practice of febrile neutropenia (FN) in pediatric cancer patients at Tikur Anbessa Specialized Hospital (TASH), Ethiopia by reviewing patients’ charts from 135 participants retrospectively. Data was entered into Epi-info 7 and exported to SPSS 20 for analysis. Results Empiric antibiotics therapy (EAT) was given to all patients in which ceftriaxone with gentamycin constituted of 71.8% followed by ceftriaxone monotherapy. EATs were converted to others in 20 (14.8%) and 2 (1.5%) patients for the first and second times respectively, mainly based on poor clinical response without conducting culture and sensitivity tests. These tests were done only for 13 (9.6%) participants and growth was seen in 5 patients; and definitive therapy was given for 2 patients. ANC value was above 500 cell/mm3 in 80.7% of patients and 98.5% of study participants were afebrile after completion FN treatment. Most of them (70.4%) were treated for FN and 7 of patients died due to all case mortality. The hospital should not rely mainly only on ceftriaxone with gentamycin as EAT and should do culture and sensitivity test to optimize therapy based on susceptibility result before conversion and modification of therapy in management of FN.

Aim:Despite improvements in diagnosis and treatment, infections are still major cause of morbidity and mortality in children with febrile neutropenia (FN). In these patients, due to inadequate inflammatory response and subtle clinical symptoms, to determine the source of infection can be challenging. Therefore, it is important to distinguish infections from other non-infectious causes, for both to choose appropriate antibiotic and to reduce the redundant antibiotic use.Materials and Methods:In this retrospective study, we aim to evaluate serial procalcitonin (PCT) levels for predicting bacteremia particularly caused by Gram-negative microorganism.Results:Among FN episodes caused by Gram-negative microorganism, the median level of second PCT sample obtained between 48 and 72 hours PCT 2 was found to be significantly higher when compared to infections caused by Coagulase-negative Staphylococcus or culture-negative confirmed infections, p value was 0.003; however, fever onset PCT 1 and C-reactive protein (CRP) 1 values showed no significant difference (p>0.05). The area under curve values demonstrated by receiver operating characteristic (ROC) analysis for CRP 1, CRP 2, PCT 1, PCT 2 were 0.664, 0.748, 0.504 and 0.842, respectively.Conclusion:This study showed that initial PCT levels were not significantly correlate with culture-confirmed bacterial infection. Therefore, initial PCT values do not help the clinicians in terms of administering or postponing empirical antibiotics at the time of fever onset. However, third day PCT levels present as a good diagnostic marker due to a higher sensitivity and specificity when comparing them to the initial values. Determination of serial PCT may enhance the diagnostic value of PCT diagnostic marker in FN episodes caused by Gram-negative bacteria with a high sensitivity (87.5%). This study also demonstrated that PCT could be used to rule out bacterial infections particularly caused by Gram-negative bacteria.

Background Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents. Febrile Neutropenia (FN) is a medical emergency on ALL that often leads to death. Nutrition status assessment on ALL patient is important because malnutrition can reduce the tolerance of chemotherapy, increase incidence of infection and decrease survival rate. Objectives To assess malnutrition as a risk factor for FN in children with ALL. Methods This case-control study was performed at Sardjito Hospital, Yogyakarta on patients aged 1 month to 18 years diagnosed with ALL and undergoing induction phase chemotherapy between January 2013 and December 2015. The case and control subjects were children with and without FN, respectively. Febrile neutropenia was confirmed by patients temperature above 38ºC at one measurement and a peripheral neutrophil count of less than 1,000/mm3. Malnutrition was defined as body weight-for-height was between -2 and

Patients with hematological malignancy have a high risk of experiencing febrile neutropenia (FN). Acute Lymphoblastic Leukemia (ALL) became one of the most cases as a cause of FN. Chemotherapy can also cause of neutropenia in almost 90% of cases and can increase the risk of developing febrile neutropenia. The administration of irrational antibiotics can cause problems such as increased side effects and resistance. The purpose of this study is to determine the rationality of antibiotics in ALL with FN patients at hospital X Surakarta. This study was an observational study with retrospectively. The research sample was met the inclusion criteria 31 patients with the purposive sampling method. Data were analyzed descriptively. An evaluation antibiotic of 31 patients ALL with FN was obtained the right indication 100% (31 patients), the right patient 100% (31 patients), the right medicine 83,87% (26 patients) and the right dose 51,61% (16 patients). The rationality of antibiotics was 51,61% (16 patients).

Abstract This report has strong implications for carefully examining the common skin signs of cancer patients receiving chemotherapy. These signs can warn clinicians of the potential for severe infections such as fatal sepsis.

Background: Haematopoietic stem cell transplantation is a curative treatment option for many haematological disorders. Infection following haematopoietic stem cell transplantation is one of the major causes of mortality. Aims: To investigate the outcomes of early cessation of empirical antibiotic treatment per protocol in febrile neutropenia patients who have undergone haematopoietic stem cell transplantation at our clinic. Study Design: Descriptive study. Methods: The present study retrospectively evaluated febrile neutropenia attacks in haematopoietic stem cell transplantation recipients during the period June 2014 - January 2015 at our haematopoietic stem cell transplantation clinic. Results: A total of 72 febrile neutropenia attacks were evaluated in 53 patients. In 46 febrile neutropenia attacks, microbiologic cultures revealed positive results. In culture-positive febrile neutropenia episodes a single bacterium was isolated in 32 cases and multiple strains were isolated in 14. In 15 patients, empirical antibiotic therapy was discontinued after 72 hours. These patients were clinically stable, without evident focus of infection and had negative culture results. Only 4 recurrent episodes were observed (27%) after cessation of antibiotherapy. No patient died as a result of recurrent infection. The 30-day and 100-day post-transplantation mortality rates of patients with febrile neutropenia episodes were 11.3% (6/53) and 3.8% (2/53), respectively. Infection-related 30-day and 100-day mortality rates were 7.5% (4/53) and 0% (0/53), respectively. Conclusion: The main message of our study is that early cessation of empirical antibiotherapy seems to be feasible in eligible patients without increasing febrile neutropenia mortality rates

There is presented a clinical observation on the problem of establishing an oncological diagnosis by a family doctor, the route to a doctor-oncologist for specific treatment with subsequent work in the brigade team and medical support during the course of chemotherapy for the prevention and timely elimination of side effects and complications.

We report a lung-invasive fungal disease with possible cutaneous needle tract seeding in a patient with a febrile neutropenia caused by the Basidiomycetes mold Inonotus spp. Although rare, Inonotus spp. should be added to the list of microorganisms causing invasive fungal disease in neutropenic patients with hematologic malignancies.

Introduction: Blood stream infections are the common infectious consequence in neutropenic patients suffering from the hematological malignancies. These infections are usually caused by a diverse group of microbes. Material and methods: A pair of blood culture was executed in the febrile neutropenic patients suffering from hematological disorders, to observe the microbiology of the blood stream infections. Identification and antimicrobial susceptibility testing were performed as per standard microbiological procedures. Results: In the present study, 27% of blood culture positivity (27/100) was observed among the enrolled febrile neutropenic patients. Gram-positive cocci including Staphylococcus aures (n=15), Coagulase negative staphylococci (n=8), Enterococcus fecalis (n1) were the predominance in comparison to Gram negative microbes (one each isolate of Klebsiella pneumonaie, Escherichia coli, Pseudomonas aeruginosa). All the isolated Gram-positive microbes were sensitive to vancomycin and linezolid. 65.2% of isolated Staphylococci were methicillin resistant (15/23). One MDR Klebsiella pneumoniae strain was also isolated, having a susceptibility to only carbapenem and polymyxin B. Conclusion: Blood culture and susceptibility testing should be performed in each case of febrile neutropenia as blood stream infections among these patients are caused by a divergent group of microbes having a varied susceptibility pattern.