Claudi S M Oude Nijhuis1, Edo Vellenga2, Simon M G J Daenen2, Winette T A van der Graaf3, Jourik A Gietema3, Harry J M Groen4, Willem A Kamps1, Eveline S J M de Bont5. 1. Division of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. 2. Division of Hematology, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands. 3. Division of Medical Oncology, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands. 4. Division of Pulmonary Diseases, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands. 5. Division of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. e.s.j.m.de.bont@bkk.azg.nl.
Abstract
OBJECTIVE: Cancer patients with febrile neutropenia after chemotherapy have a variable risk of bacterial infection. Especially Gram-negative bacteremia is associated with high mortality and/or morbidity. Early diagnosis of patients with Gram-negative bacteremia at the onset of febrile neutropenia is potentially useful in tailoring therapy. DESIGN AND SETTING: Prospective study at the Department of Pediatric Oncology and Internal Medicine of a university hospital. PATIENTS: Were analyzed 66 febrile neutropenic episodes in 57 adults and children. Patients were divided into four groups: those with Gram-negative bacteremia, Gram-positive bacteremia, clinical sepsis, or fever of unknown origin. MEASUREMENTS AND RESULTS: Plasma lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP) concentrations were determined. LBP at the onset of febrile neutropenia was significantly higher in patients with Gram-negative bacteremia than those with fever of unknown origin and those with Gram-positive bacteremia. Using a cutoff value for LBP proved to have much greater sensitivity, specificity, and positive and negative predictive value for Gram-negative bacteremia than the best cutoff value for CRP. CONCLUSIONS: An initial high LBP level might predict Gram-negative bacteremia in cancer patients with febrile neutropenia. These results may have potential clinical impact by allowing therapy to be initiated for these patients at a very early stage.
OBJECTIVE:Cancerpatients with febrile neutropenia after chemotherapy have a variable risk of bacterial infection. Especially Gram-negative bacteremia is associated with high mortality and/or morbidity. Early diagnosis of patients with Gram-negative bacteremia at the onset of febrile neutropenia is potentially useful in tailoring therapy. DESIGN AND SETTING: Prospective study at the Department of Pediatric Oncology and Internal Medicine of a university hospital. PATIENTS: Were analyzed 66 febrile neutropenic episodes in 57 adults and children. Patients were divided into four groups: those with Gram-negative bacteremia, Gram-positive bacteremia, clinical sepsis, or fever of unknown origin. MEASUREMENTS AND RESULTS: Plasma lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP) concentrations were determined. LBP at the onset of febrile neutropenia was significantly higher in patients with Gram-negative bacteremia than those with fever of unknown origin and those with Gram-positive bacteremia. Using a cutoff value for LBP proved to have much greater sensitivity, specificity, and positive and negative predictive value for Gram-negative bacteremia than the best cutoff value for CRP. CONCLUSIONS: An initial high LBP level might predict Gram-negative bacteremia in cancerpatients with febrile neutropenia. These results may have potential clinical impact by allowing therapy to be initiated for these patients at a very early stage.
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