Cargando…

History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs

Background: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here...

Descripción completa

Detalles Bibliográficos
Autores principales: Andrès, Emmanuel, Mourot-Cottet, Rachel, Maloisel, Frédéric, Keller, Olivier, Vogel, Thomas, Séverac, François, Tebacher, Martine, Gottenberg, Jacques-Eric, Weber, Jean-Christophe, Kaltenbach, Georges, Goichot, Bernard, Sibilia, Jean, Korganow, Anne-Sophie, Herbrecht, Raoul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664007/
https://www.ncbi.nlm.nih.gov/pubmed/28954408
http://dx.doi.org/10.3390/jcm6100092
_version_ 1783274918773784576
author Andrès, Emmanuel
Mourot-Cottet, Rachel
Maloisel, Frédéric
Keller, Olivier
Vogel, Thomas
Séverac, François
Tebacher, Martine
Gottenberg, Jacques-Eric
Weber, Jean-Christophe
Kaltenbach, Georges
Goichot, Bernard
Sibilia, Jean
Korganow, Anne-Sophie
Herbrecht, Raoul
author_facet Andrès, Emmanuel
Mourot-Cottet, Rachel
Maloisel, Frédéric
Keller, Olivier
Vogel, Thomas
Séverac, François
Tebacher, Martine
Gottenberg, Jacques-Eric
Weber, Jean-Christophe
Kaltenbach, Georges
Goichot, Bernard
Sibilia, Jean
Korganow, Anne-Sophie
Herbrecht, Raoul
author_sort Andrès, Emmanuel
collection PubMed
description Background: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital. Patients and methods: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg, France). Results: Mean patient age was 52.2 years old (range: 18–93) and gender ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%), neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main clinical presentations upon hospitalization included isolated fever (30%), sore throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%), septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was 0.13 × 10(9)/L (range: 0–0.48). While in hospital, 22 patients (28.9%) worsened clinically and required intensive care unit placement. All patients were promptly treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth factors. Mean duration of hematological recovery (neutrophil count ≥1.5 × 10(9)/L) was 7.5 days (range: 2–21), which was reduced to 0.7 days (range: 2–16) (p = 0.089) with hematopoietic growth factors. Outcome was favorable in 89.5% of patients, whereas eight died. Conclusions: Like in oncology and myelosuppressive chemotherapy settings, idiosyncratic febrile neutropenia is typically serious, about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock, with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia, modern and timely management (immediate broad spectrum antibiotherapy, hematopoietic growth factors) may reduce infection-related mortality. All practitioners should be aware of this potential side-effect that may even occur in the event of “daily medication” exposure.
format Online
Article
Text
id pubmed-5664007
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-56640072017-11-06 History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs Andrès, Emmanuel Mourot-Cottet, Rachel Maloisel, Frédéric Keller, Olivier Vogel, Thomas Séverac, François Tebacher, Martine Gottenberg, Jacques-Eric Weber, Jean-Christophe Kaltenbach, Georges Goichot, Bernard Sibilia, Jean Korganow, Anne-Sophie Herbrecht, Raoul J Clin Med Article Background: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital. Patients and methods: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg, France). Results: Mean patient age was 52.2 years old (range: 18–93) and gender ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%), neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main clinical presentations upon hospitalization included isolated fever (30%), sore throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%), septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was 0.13 × 10(9)/L (range: 0–0.48). While in hospital, 22 patients (28.9%) worsened clinically and required intensive care unit placement. All patients were promptly treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth factors. Mean duration of hematological recovery (neutrophil count ≥1.5 × 10(9)/L) was 7.5 days (range: 2–21), which was reduced to 0.7 days (range: 2–16) (p = 0.089) with hematopoietic growth factors. Outcome was favorable in 89.5% of patients, whereas eight died. Conclusions: Like in oncology and myelosuppressive chemotherapy settings, idiosyncratic febrile neutropenia is typically serious, about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock, with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia, modern and timely management (immediate broad spectrum antibiotherapy, hematopoietic growth factors) may reduce infection-related mortality. All practitioners should be aware of this potential side-effect that may even occur in the event of “daily medication” exposure. MDPI 2017-09-26 /pmc/articles/PMC5664007/ /pubmed/28954408 http://dx.doi.org/10.3390/jcm6100092 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Andrès, Emmanuel
Mourot-Cottet, Rachel
Maloisel, Frédéric
Keller, Olivier
Vogel, Thomas
Séverac, François
Tebacher, Martine
Gottenberg, Jacques-Eric
Weber, Jean-Christophe
Kaltenbach, Georges
Goichot, Bernard
Sibilia, Jean
Korganow, Anne-Sophie
Herbrecht, Raoul
History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs
title History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs
title_full History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs
title_fullStr History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs
title_full_unstemmed History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs
title_short History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs
title_sort history and outcome of febrile neutropenia outside the oncology setting: a retrospective study of 76 cases related to non-chemotherapy drugs
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664007/
https://www.ncbi.nlm.nih.gov/pubmed/28954408
http://dx.doi.org/10.3390/jcm6100092
work_keys_str_mv AT andresemmanuel historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT mourotcottetrachel historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT maloiselfrederic historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT kellerolivier historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT vogelthomas historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT severacfrancois historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT tebachermartine historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT gottenbergjacqueseric historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT weberjeanchristophe historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT kaltenbachgeorges historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT goichotbernard historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT sibiliajean historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT korganowannesophie historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs
AT herbrechtraoul historyandoutcomeoffebrileneutropeniaoutsidetheoncologysettingaretrospectivestudyof76casesrelatedtononchemotherapydrugs