Assessment of the Management of Neutropenic Fever in Adult Patients with Hematologic Malignancies at Tikur Anbessa Specialized Hospital
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Date
2017-05
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Addis Ababa University
Abstract
Cancer patients with hematologic malignancies are at a greater risk of complications either from the disease itself or from the drug treatment. Among the disease complications, neutropenic fever is the most common cause of morbidity and mortality. Although practically challenging, initiation of appropriate empirical antibiotic treatment within the first hour of the infection is lifesaving. The objective of this study was to assess the management practice of neutropenic fever in adult patients with hematological malignancies at Internal Medicine ward of Tikur Anbessa Specialized Hospital. The study was conducted using a retrospective cross-sectional study design and a five-year data was collected from patient medical charts. Simple descriptive statistics and logistics regression were employed to analyze and present the data. Out of the total 682 hematologic malignancy admitted patients, 294 (43%) patients were developed neutropenic fever. Acute Myelogenous Leukemia (AML) and Acute Lymphocytic Leukemia (ALL) were the two most common hematological malignancies that developed neutropenic fever (NF). Common pathogens identified as a cause of NF were Coagulase negative staphylococcus and Escherichia coli. AML, ALL, culture and sensitivity test being done and positive culture and sensitivity test are associated with appropriate management practice. Based on standard treatment guideline of Infectious Disease Society of America (IDSA), more than half of the patients with NF received unnecessary use of empiric combined antibiotic (52.4%), additional antifungal with antiviral therapy and modification of antibacterial. However, it is difficult to decide whether appropriate or not with limited institutional setup. Since the prevalence of NF in TASH is high and the management practice of it seems inadequate, improvement in institutional setup and developing specific protocol is recommended to optimize treatment of such patients. Key words: Hematologic malignancy, Neutropenic fever, Management practice, Monotherapy, Combined therapy, Treatment modification
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Hematologic malignancy, Neutropenic fever, Management practice