EYÜP NACİ TİFTİK, Özlem KANDEMİR, Elif ŞAHİN, Ali KAYA

Febril nötropenik kanser hastalarında gözlenen infeksiyonlar ve tedavi başarısını etkileyen faktörlerin değerlendirilmesi

Bu çalışmada Nisan 2004-Aralık 2005 arasında izlenen nötropenik ateş tanılı kanser hastalarında gözlenen infeksiyonlar, bu hastaların özellikleri ve tedavi başarısını etkileyen faktörlerin incelenmesi amaçlanmıştır. Seksenbir febril nötropenik hasta değerlendirilmiştir. Her hastanın sadece ilk atağı incelemeye alınmıştır. Risk grubunu belirlemede The Multinational Association for Supportive Care in Cancer (MASCC) skorlama sistemi kullanılmıştır. Hastalardaki ateşli ataklar mikrobiyolojik olarak tanımlanmış infeksiyonlar, klinik olarak tanımlanmış infeksiyonlar ve nedeni bilinmeyen ateş (NBA) olarak kategorize edilmiştir. Tedavinin sonuçları “tedavi başarılı” veya “modifikasyonla başarılı/veya başarısız” olarak gruplandırılmıştır. Olguların 37’si kadın, 44’ü erkek ve yaş ortalamaları 44.76 ± 16.8 (16-85) idi. Ellialtısında altta yatan primer hastalık hematolojik malignansi, 25’inde solid tümördü. MASCC skorlama sistemine göre atak sırasında hastaların 44’ü düşük risk, 37’si yüksek riskli grupta yer almaktaydı. Hastaların 25’inde (% 31) ateşin nedeni bulunamamış, 33’ünde (% 41) tanı klinik olarak, 23’ünde (% 28) mikrobiyolojik olarak konmuştur. Bu hasta grubundan etken olarak en sık Gram negatif mikroorganizmalar (% 50) izole edilmiştir. Empirik tedavide monoterapi olarak en sık karbapenemler (47 olguda) kullanılmıştır. Tedavi başarısı genel olarak değerlendirildiğinde 46 hastada (% 57) başarılı, 9’unda (% 11) modifikasyonla başarılı, 26’sında (% 32) başarısızlık saptanmıştır. MASCC skor indeksi (risk grubu), nötropeni süresi, ateşin devam etme süresi, infeksiyon kategorisi tedavi başarısını etkileyen faktörler olarak tespit edilmiştir.

Anahtar Kelimeler:

Neoplazmlar, Nöbetler, febril, Tedavi sonucu, Zaman faktörleri, Nötropeni

Evaluation of infections and factors affecting treatment success in febrile neutropenic cancer patients

In this study, we aimed to evaluate the infections, their characteristics and the predictors of treatment success in febrile neutropenic cancer patients, consulted between April 2004-December 2005. Eighty-one febrile neutropenic patients were evaluated. Only first attacks of each patient were included in the study. The Multinational Association for Supportive Care in Cancer (MASCC) scoring system was used to determine the risk group. The febrile attacks were categorized as “microbiologically” and “clinically documented” infections and “fever of unknown origin (FUO)”. The results of treatment were grouped as “successful” or “successful only after modification of treatment/failure”. Of these patients 37 were female, 44 were male and the mean age was 44.7±16.8 years. The underlying diseases were hematological malignancies in fifty-six and solid tumors in twenty-five patients. Forty-four of the patients were in the low risk group and thirty-seven in the high risk group during attacks according to MASCC scoring system. The etiology of fever was undetected in 31 % patients, the infection was clinically documented in 41 %, and microbiologically documented in 28 %. Of the pathogens, Gram negative microorganisms were the most frequent ones (50 %). Carbapenems were the most commonly used antimicrobial agents for the ampiric monotherapy. Response to treatment was successful in 46 (57 %) of the patients with neutropenic fever, whereas modification of the treatment regimen was required for success in 9 patients (11 %) and treatment failed in another 26 (32 %). The MASCC score index, the duration of neutropenia and fever, the category of infection were the factors which affected the success of therapy.

Keywords:

Neoplasms, Seizures, Febrile, Treatment Outcome, Time Factors, Neutropenia,

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