Secondary Infections in Febrile Neutropenia in Hematological Malignancies: More Than Another Febrile Neutropenic Episode

摘要

Objective: Febrile neutropenic episodes (FNEs) are among the major causes of mortality in patients with hematologicalmalignancies. Secondary infections develop either during the empirical antibiotic therapy or 1 week after cessation of therapyfor a FNE. The aim of this study was to investigate the risk factors associated with secondary infections in febrile neutropenicpatients.Materials and Methods: We retrospectively analyzed 750 FNEs in 473 patients between January 2000 and December 2006.Results: Secondary infections were diagnosed in 152 (20%) of 750 FNEs. The median time to develop secondary infectionwas 10 days (range: 2-34 days). The duration of neutropenia over 10 days significantly increased the risk of secondaryinfections (p0.05). While fever ofunknown origin (p=0.005) and catheter-related bacteremia (p<0.001) were less frequently observed in secondary infections,the frequency of microbiologically (p=0.003) and clinically (p<0.001) documented infections, fungal pneumonias (p<0.001),infections related to gram-positive bacteria (p=0.04) and fungi (p<0.001), and 30-day mortality rate (p<0.001) were significantlyhigher in cases of secondary infections (p<0.001).Conclusion: Secondary infections should be regarded as life-threatening complications of febrile neutropenia. Secondaryinfections represent a more severe and mortal complication and cannot be regarded just as another FNE.