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Dryad

A practical approach to febrile cancer patients: Diagnostic stewardship in Oncology units

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Aug 21, 2024 version files 49.93 KB

Abstract

INTRODUCTION: Cancer and cytotoxic chemotherapy used for its treatment predispose to severe and often fatal infections. Prompt diagnosis and timely antibiotic therapy is crucial, with delays in initiating therapy having high mortality. Complete blood counts (CBC) are an inexpensive, standardized, preliminary investigation for management and follow-up of cancer patients with diagnostic and prognostic value.

METHOD: To study the types of infections associated with various cancers on chemotherapy, their etiologies and susceptibility patterns, and the hematological profile of these patients as predictors of infection.

RESULTS: A total of 21 patients (12 solid and 9 hematological malignancies) presented with 31 febrile episodes. WBC count (2079 cells/cu.mm), percentage of neutrophils (52.9%), absolute neutrophil (137.5 cells/cu.mm) and platelet counts (1,77,507 cells/cu.mm) were significantly lower in the 11 febrile neutropenic patients. Absolute lymphocyte count (412.7 cells/cu.mm) was reduced with strikingly lower NLR ratio (6.07) in neutropenic patients. Laboratory and radiological evidence were present in 14/15 episodes in hematological malignancies as compared to 10/16 episodes in solid malignancies (p value-0.0218). Unexplained clinical sepsis was common in solid malignancies (p-0.0202). Majority of documented infections were bacterial, caused by Gram negative bacilli, showing multi-drug resistance. Infectious etiologies were identified in 71.4% patients with febrile neutropenia >5days. Bacterial infections developed within 2 days of neutropenia, whereas viral infections and fungal infections manifested in prolonged neutropenia. Multi-site infections and higher mortality were seen in patients with febrile neutropenia. (p<0.04)

CONCLUSION: Febrile neutropenia is a common complication among patients on cancer chemotherapy with increased risk of morbidity and mortality. Early, rapid yet accurate diagnosis is key to prompt intervention. Hematological parameters such as TLC, platelet count, NLR and PLR are promising biomarkers in conjunction with morphological changes of neutrophils, thus proving CBC and peripheral smear to be simple, easily available, cost-effective and highly dependable screening tools especially in resource-poor settings.