Neutropenic Fever in Lung Cancer: Clinical Aspects Related to Mortality and Antibiotic Failure

BACKGROUND AND OBJECTIVES: Lung cancer (LC) is the leading cause of cancer death.Patients treated with chemotherapy are at risk of developing chemotherapy-induced febrile neutropenia (FN), a potentially life-threatening complication.The aims of this study were (1) to characterize FN admissions of patients with LC in a pulmonology department, and (2) to determine associations between patient profiles, first-line antibiotic failure (FLAF) and mortality. METHODS: Retrospective observational case-series, based on the analysis of medical records of LC patients that required hospitalization due to chemotherapy-induced FN. RESULTS: A total of 42 cases of FN were revised, corresponding to 36 patients, of which 86.1% were male, with a mean age of 66.71±9.83 years.Most patients had a performance status (PS) equal or less than 1, and metastatic disease was present in 40.5%(n=17).Respiratory tract infections accounted for 42.9%(n=18) of FN cases, and multidrug-resistant Staphylococcus aureus was the most isolated agent.The mortality rate was 16.7%(n=7), and the FLAF was 26.2%(n=11).Mortality was associated with a PS≥2(P=0.011), infection by a Gram-negative agent (P=0.001) and severe anemia (P=0.048).FLAF was associated with longer hospitalizations (P=0.020), PS≥2(P=0.049), respiratory infections (P=0.024), and infection by a Gram-negative (P=0.003) or multidrug-resistant agent (P=0.014). CONCLUSIONS: Lower PS, severe anemia, and infections by Gram-negative or multi-resistant agents seem to be associated with worse outcomes in FN patients.