Systematic review of case reports concerning adults suffering from neutropenic enterocolitis

RESUMEN

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ABSTRACT

Introduction. Neutropenic enterocolitis (NEC) is awell recognised clinical-pathological and life-threateningcomplication in patients suffering from severalconditions, including solid and haematologicalmalignancies or aplastic anaemia.Objective. This review was aimed at evaluatingoverall NEC mortality rate, describing clinical diagnosticfindings and therapeutical interventions reportedin the literature and generating a hypothesisregarding factors influencing mortality and surgicalintervention.Materials and methods. An advanced search wasmade in Medline, Embase, Lilacs and Google. Additionalstrategies included manual search of specificjournals. Reports were considered if they describedcase definition, inclusion and exclusion criteria.Results. 275 cases were selected; 109 were from individualdata and 40 from grouped data. Comparingdata between case reports and case series revealedno significant differences related to mortality, surgicalintervention, sex or age. Higher mortality (÷2 =7.51 p = 0.006) was found in women (50%) comparedto men (28%). No significant difference wasfound between antibiotic combinations and mortality(÷2 = 12.85 df 13 p = 0.45).Mortality (÷2 = 3.89 df 1, p = 0.049), surgical intervention(÷2 = 7.64 df 1, p = 0.006) and duration of diarrhoea(÷2 = 4.71 df 1, p = 0.043) were significantly differentin 26.4% of individuals using antifungal agents;death occurred in 81% of patients! who did not receivesuch medication compared to 19% individualsreported as being treated with antifungal agents.Conclusion. The current evidence suggests that antifungalagents should be used early in patients sufferingfrom NEC. However, this hypothesis must beevaluated in multi-centric, randomised controlledtrials