Özet:

INTRODUCTION: The epidemiology of pathogens responsible of febrile neutropenia (FEN) has changed and so did the diagnostic tools in the field of infectious diseases. This study examined the changing paradigms and prognostic factors in FEN episodes. METHODS: This was a prospective and observational study of 145 adult patients aged 18 and older with solid tumor and hematological malignancies and who received FEN treatment at the our cancer center between April 2020 and April 2021; 176 FEN episodes developed in patients and were examined. RESULTS: Hematological malignancy was present in 70.3% (n=102) of the 145 patients. Microbiologically-confirmed infections were seen in 46% of FEN episodes. The most common focus of infection was lower respiratory tract infections with 27.1%. In 66.2% (n=45) of FEN episodes, only gram-negative microorganisms grew while only gram-positive microorganisms grew in 19.1% (n=13). Bacteremia was significantly higher in patients with hematological malignancies versus patients with solid organ tumors (p<0.001). Deep neutropenia on day zero was associated with bacteremia (p<0.001), but the relationship between prolonged neutropenia and bacteremia could not be demonstrated (p=0.34). FEN-related mortality was 9.7% (n=17). The risk of mortality in FEN was 10.25-fold higher in patients with pneumonia and 6.05-fold higher in patients with prolonged neutropenia. DISCUSSION AND CONCLUSION: We determined that the frequency of pneumonia increased in the FEN clinic due to the effects of newly introduced chemotherapeutics. Gram-negative microorganisms were more common in the causative profile unlike the previous decade. Pneumonia and prolonged neutropenia increase mortality. Comprehensive multicenter studies will allow for the development of new management algorithms for changing paradigms.

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