简介发热性中性粒细胞减少症是接受癌症治疗的患者中常见的医疗紧急情况,可以延迟和改变治疗过程,甚至导致可怕的结果。包括死亡。化疗后引起的中性粒细胞减少症患者发烧的原因可能会使治疗医师感到困惑。对文献的回顾表明,血液培养结果可以确定仅约10%至25%的患者发热性中性粒细胞减少症的原因。我们研究的目的是测量血培养阳性的发生率,尿液培养物,和其他体液培养导致化疗诱导的中性粒细胞减少症,并进一步将发热发作分为三种中性粒细胞减少性发热综合征,如微生物学记录,临床怀疑,或者不明原因的发烧,分别。方法我们对399例化疗诱导的中性粒细胞减少性发热进行了前瞻性观察研究,目的是将其分为三种中性粒细胞减少综合征之一。我们试图记录这些患者发烧的原因。我们还注意到他们使用的癌症治疗方案的类型,并将他们的临床特征与他们的体液培养相关联,包括血培养,尿液培养物,和其他体液培养物。然后,我们将每个发烧发作分为三种中性粒细胞减少综合征之一。结果我们研究了399例发热性中性粒细胞减少症。我们能够以微生物学方式记录39%的病例中发烧的原因,399个血培养物中有51个(13%),这与现有文献相当,尿液培养显示399种培养物中有62种(16%)生长,而其他身体文化,如脓液文化,胆汁培养,在399次发作中,有42次(10%)出现了细支气管肺泡灌洗培养。在血液和尿液培养物中分离出的最常见细菌是大肠杆菌。累计,包括血,尿液,和体液培养,我们能够将39%(399例病例中的155例)的发热性中性粒细胞减少症发作分类为微生物学记录.通过仔细的病史记录和广泛的体格检查,在临床上怀疑发烧的原因有31%(399中的125),没有血液培养中的生长证据。尿液培养物,或任何其他体液培养。119例(30%)患者的发烧原因仍然未知,并被归类为发烧原因不明。结论我们总结说,中性粒细胞减少症患者的发热研究应包括全面的病史和血液临床评估,尿液,和其他体液培养,而不是仅仅依靠血液培养结果。我们建议进一步将患者分为三种中性粒细胞减少性发热综合征之一,比如那些有微生物学记录的,临床怀疑,或未知。我们的血液培养能够给我们13%的阳性率,而微生物学,我们能够在39%的患者中分离出一种可能引起发烧的生物。31%的病人在临床上怀疑发烧的原因,但是我们在微生物学上没有成功记录血液中的任何培养物生长,尿液,或任何其他体液培养。在119例(30%)发热性中性粒细胞减少症发作中,发烧的原因仍然是一个谜,我们不知道没有任何微生物或临床线索。
Introduction Febrile neutropenia is a commonly encountered medical emergency in patients undergoing cancer treatment and can delay and modify the course of treatment and even lead to dire outcomes, including death. The cause of fever in a post-chemotherapy-induced neutropenic patient can be confusing to treating physicians. A review of the literature demonstrated that blood culture results could determine the cause of febrile neutropenia in only approximately 10% to 25% of patients. The objective of our study was to measure the incidence of positive blood cultures, urine cultures, and other body fluid cultures resulting in chemotherapy-induced neutropenia and further classify fever episodes into three neutropenic fever syndromes, such as microbiologically documented, clinically suspected, or unknown causes of fever, respectively. Methods We conducted a prospective observational study on 399 chemotherapy-induced neutropenic fever episodes with the aim of classifying them into one of the three neutropenic syndromes. We tried to document the cause of the fever in these patients. We also noted the type of cancer treatment regimen they were on and correlated their clinical profile with their body fluid cultures, including blood cultures, urine cultures, and other body fluid cultures. We then categorized each fever episode into one of three neutropenic syndromes. Results We studied 399 febrile neutropenic episodes. We were able to microbiologically document the cause of fever in 39% of the cases, and we obtained growth in 51 out of 399 blood cultures (13%), which was comparable to the available literature, and urine culture showed growth in 62 out of 399 cultures (16%), while other body cultures such as pus culture, bile culture, and bronchioalveolar lavage cultures collectively showed growth in 42 out of 399 episodes (10%). The most common bacteria isolated in both blood and urine cultures were Escherichia coli. Cumulatively, including blood, urine, and body fluid cultures, we were able to classify 39% (155 out of 399 cases) of febrile neutropenic episodes as microbiologically documented. The cause of fever was clinically suspected by means of careful history taking and an extensive physical examination in 31% (125 out of 399) without growth evidence in blood cultures, urine cultures, or any other body fluid culture. The cause of fever remained unknown in 119 cases (30%) of patients and was classified under the unknown cause of fever. Conclusions We conclude by stating that the study of fever in a neutropenic patient should include a thorough history and clinical evaluation of blood, urine, and other body fluid cultures instead of solely relying on blood culture results. We recommend further classifying patients into one of the three neutropenic fever syndromes, such as those that are microbiologically documented, clinically suspected, or unknown. Our blood cultures were able to give us a 13% positivity rate, whereas microbiologically, we were able to isolate an organism likely causing fever in 39% of patients. The cause of fever was suspected clinically in 31% of patients, but we were unsuccessful in microbiologically documenting any culture growth in blood, urine, or any other body fluid culture. The cause of fever remained a mystery and unknown to us without any microbiological or clinical cues in 119 cases (30%) of febrile neutropenic episodes.