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Incidence of Febrile Neutropenia After Chemotherapy in Hospitalised Patients Appears Lower Than Expected in Canada: Presented at ICC

By Louise Gagnon

TORONTO -- June 23, 2009 -- The use of antibiotic prophylaxis delays the onset of infections in patients with haematologic malignancies, according to a multicentre, observational, retrospective review presented here at the 26th International Congress of Chemotherapy and Infection (ICC).

Deepali Kumar, MD, Department of Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, presented the study at a poster session on June 20.

For the study, researchers collected data on the presence of fever and febrile neutropenia (FN) in patients who had undergone haematopoietic stem cell transplantation (HSCT) or chemotherapy to treat acute leukaemia (AL).

Patients were followed until death, discharge from hospital, or a maximum hospital stay of 60 days.

A total of 457 patients were initially screened, with 223 (48.8%) having developed FN. Of those, 101 patients received chemotherapy to treat AL, whereas 122 underwent HSCT. The mean age of the sample was 48.5 years.

Of the patients with FN, 16.1% received active therapy for an infection at the onset of chemotherapy or HSCT. Of the 187 patients who did not receive active therapy, 107 (57.2%) received antibacterial prophylaxis and 90 (48.1%) received antifungal prophylaxis, respectively.

A total of 14 patients (6.3%) died after 60 days from the end of anti-infective therapy, and the remaining 209 patients (93.7%) were discharged from the hospital at the same time point. Clinically documented infections occurred in 24.7% of patients.

Investigators analysed whether any statistically significant difference occurred among patients who received antibacterial prophylaxis versus no prophylaxis in mean duration of fever (7.6 vs 4.8 days, respectively; P = .4) or overall infection rate (64.9% vs 60.5%; P = .5).

Researchers did observe that patients on antibiotic prophylaxis had fewer documented infections at day 30 (P = .027).

"The time to getting infection was delayed," said Dr. Kumar. "Antibiotic prophylaxis appeared to delay infection in the first month."

Patients with documented infections were more likely to have longer hospitalisation than those who did not have infections (37.6 vs 29.9 days; P = .006), but they did not have greater mortality than those who had FN and no documented infection (P = .47). Prolonged duration of neutropenia was positively correlated with the presence of documented infection (P = .003).

The study revealed that appropriate antibiotic therapy was initiated in a prompt manner in this patient population, allowing for the low rate of complications and death, said Dr. Kumar, adding that the incidence of febrile neutropenia was relatively low.

Funding for this study was provided by Merck Frosst Canada Ltd.

[Presentation title: Febrile Neutropenia in Patients With Hematologic Malignancy: A Canadian Multi-Center Observational Study. Abstract P298]

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