Fever, neutropenia and malignancy: A clinical syndrome in evolution

During a 12‐month period, 43 consecutive episodes of new fever in neutropenic cancer patients were evaluated. A two‐drug combination of cephalothin, gentamicin or carbenicillin was used empirically for each episode. Overall mortality for this series was 28%. Microbiologic documentation of infection occurred in only nine of 43 episodes but a probable site of infection was observed in 14 others. The lungs were the most common site of infection and pneumonia was associated with a 100% fatal outcome. Despite the large number of febrile episodes with no infectious isolates, response to empiric broad‐spectrum antibiotics was common (n = 23) and was associated with 4% mortality compared to 55% mortality in episodes with no response. Superinfection occurred only in patients treated with antibiotics longer than 7 days (4 of 30). Bone marrow recovery was associated with lower mortality but was not essential for survival. The routine use of empiric broad‐spectrum antibiotics for all unexplained febrile episodes in neutropenic cancer patients has led to an increased frequency of culture‐negative episodes. Care must be taken to avoid over‐use of these empiric drugs.