Outpatient Treatment with Intravenous Antimicrobial Therapy in Patients with Febrile Neutropenia and Hematologic Malignancies

OBJECTIVES: The purpose of this study is to evaluate outcomes like success of the initial therapy; failure of outpatient treatment and death in outpatient treatment with intravenous antimicrobial therapy in patients with febrile neutropenia (FN) and hematologic malignancies. In addition, it was compared clinics, laboratory data and Multinational Association for Supportive Care of Cancer index (MASCC) with failure of outpatient treatment and death.

PATIENTS AND METHODS: In a retrospective study we evaluated FN following chemotherapy events that were treated initially with Cefepime, with or without Teicoplanin.

RESULTS: Of the 178 FN episodes in 128 patients, it was observed success of initial therapy in 63.5% events, failure of outpatient treatment in 20.8% and death in 6.2%. In multivariate analysis, significant risks of failure of outpatient treatment were smoking (OR: 3.14, IC: 1.14 – 8.66, p=0.027) and serum creatinine > 1.2mg/dL (OR: 7.97, IC: 2.19 – 28.95, p = 0.002). About death, the risk was pulse oximetry < 95% (OR: 5.8, IC: 1.50 – 22.56, p = 0.011). Analyzing MASCC index, 165 events were classified as low risk and 13 as high-risk. Failure of outpatient treatment were reported in connection with 7 (53.8%) high-risk episodes and 30 (18.2%) low-risk, p=0.006. In addition, death in 7 (4.2%) lowrisk and 4 (30.8%) high-risk events, p=0.004.

CONCLUSIONS: The outpatient treatment with intravenous antibiotic was satisfactory. The risks: smoking, serum creatinine elevated and pulse oximetry should be considered in FN evaluation. It was validated MASCC index in Brazilian population.