Bacteremia in adult cancer patients with apparently stable febrile neutropenia: data from a cohort of 692 consecutive episodes from a single institution.

BACKGROUND: Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment. OBJECTIVE: To assess the risk factors and the impact of bacteremia in ASPs. METHODS: We retrospectively analyzed 861 consecutive episodes of FN that were classifed according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting. RESULTS: We classifed 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specifcity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward. LIMITATIONS: A single-center, retrospective analysis, and the absence of a validation set to test the model's discriminatory ability. CONCLUSIONS: Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identifed several variables that could improve the prognostic classifcation of clinically stable FN.

Recommendations for the treatment of invasive fungal infection caused by filamentous fungi in the hematological patient.

Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results.