Pulmonary infiltrations in febrile patients with neutropenia. Risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study

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Item Type:	Article
Title:	Pulmonary infiltrations in febrile patients with neutropenia. Risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study
Creators Name:	Maschmeyer, G., Link, H., Hiddemann, W., Meyer, P., Helmerking, M., Eisenmann, E., Schmitt, J. and Adam, D.
Abstract:	BACKGROUND: Different empirical approaches to antimicrobial treatment of lung infiltrates in patients with neutropenia were studied within a prospective, randomized multicenter trial. METHODS: Patients with neutropenia with hematologic malignancies and fever of 38.5 degrees C or higher associated with newly diagnosed lung infiltrates were randomized for an initial therapy with acylaminopenicillin plus aminoglycoside (Group A), third-generation cephalosporin plus aminoglycoside (Group B), or the double beta-lactam combination (Group C), each in combination with rifampin. Nonresponders were given empirical amphotericin B plus 5-fluorocytosine beginning on day 4, day 5, or day 6 under study. RESULTS: Of 295 patients entered, 91.2% were evaluable. Complete response was obtained in 61.3% with no significant difference between treatment groups. The addition of rifampin did not improve treatment results. Only 27.1% of patients achieved a complete response by antibiotic therapy without additional antifungal therapy. Fungi dominated in cases of microbiologically documented infections and were associated with a poorer outcome compared with bacterial pneumonias. The trend of leukocyte counts under study had a highly significant effect on the outcome of infection. CONCLUSIONS: Lung infiltrates in febrile patients with neutropenia represent a high risk of treatment failure. Persistent neutropenia has a significantly adverse effect on the outcome of infection. Incorporation of systemic antifungal agents into first-line therapy, particularly in selected high-risk subgroups, might improve future treatment results. The quality of diagnostic techniques to establish the etiology of pulmonary infiltrates needs to be improved.
Keywords:	Anti-Bacterial Agents, Antifungal Agents, Bacterial Infections, Fever, Leukemia, Lung Diseases, Fungal Lung Diseases, Non-Hodgkin Lymphoma, Myelodysplastic Syndromes, Neutropenia, Prognosis, Prospective Studies, Risk Factors, Treatment Outcome
Source:	Cancer
ISSN:	0008-543X
Publisher:	Wiley
Volume:	73
Number:	9
Page Range:	2296-2304
Date:	1 May 1994
Official Publication:	https://doi.org/10.1002/1097-0142(19940501)73:9<2296::AID-CNCR2820730910>3.0.CO;2-7
PubMed:	View item in PubMed

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