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Differences between first and subsequent fevers during prolonged neutropenia
Author(s) -
Wingard John R.,
Santos George W.,
Saral Rein
Publication year - 1987
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19870215)59:4<844::aid-cncr2820590431>3.0.co;2-u
Subject(s) - medicine , sepsis , neutropenia , gentamicin , leukopenia , fever of unknown origin , febrile neutropenia , antibiotics , bacteremia , gastroenterology , surgery , chemotherapy , microbiology and biotechnology , biology
Fever during neutropenia before engraftment was studied in 86 consecutively treated patients undergoing allogeneic bone marrow transplantation. Eighty‐four of the 86 patients experienced 132 febrile episodes. Only 26% of the patients had one fever which resolved with antibiotics. The rest required modification of antimicrobial therapy because of refractory fever (32%) or recurrent fevers (42%). The 121 fevers which occurred during neutropenia were analyzed to determine differences between first and subsequent fevers (79 and 42 episodes, respectively). The frequency of sepsis (23%) and defervescence (64%) did not differ between first and subsequent fevers. Presumed localized infection (PLI) was identified in 75% of first fever but in only 28% of subsequent fevers ( P = 0.2). Of the PLI identified, oropharyngeal mucosal disease accounted for 68% during first fever but only 38% during subsequent fevers ( P = 0.02). Although sepsis in first fever was more frequently associated with PLI than sepsis in subsequent fevers (61% versus 10%, P = 0.01), overall, patients with PLI had a lower frequency of sepsis than those without (17% versus 32%, P = 0.04). Gram‐negative pathogens were uniformly gentamicin sensitive in sepsis during first fever but were mostly gentamicin‐resistant in sepsis during subsequent fevers ( P = 0.01). Cancer 59:844‐849, 1987.