Saleem Ahmad Siddiqui, Mofazzel Hossain.
Neutropenia and Sepsis - Experience in Acute Myeloid Leukaemia.
Pak Armed Forces Med J Jan ;48(2):72-7.

Neutropenia and sepsis are closely related. Chemotherapy for acute myeloid leukeamia (AML) induces severe prolonged neutropenia. We investigated prospectively the pattern of sepsis in neutropenic patients in a set up where total protected environment and strict aseptic measures are difficult to enforce. Between October 1996 and September 1998 total of 90 myelosupressive courses of chemotherapy (induction & intensification) in 30 de novo AML cases in age group 20 - 60 years were studied. No prophylactic antibiotic was administered during neutropenia till they had fever (oral temperature> 100.4°F) when prompt therapy with antimicrobials covering gram negative and gram positive microbes were instituted. Nadir neutrophil counts occurred on a mean of 12.24 days from start of chemotherapy and 97.77% of patients attained severe neutropenia absolute neutrophil count (ANC < 500/cmm). Febrile episodes were observed in 97.77% of neutropenic courses. Septicemia was associated with fever in 36.36% of neutropenic courses, gram positive organisms were isolated in 75% of septicemia & 78% of culture positivity, 28.40% febrile neutropenic courses had no clinical or laboratory evidence of infection. The microbials most commonly observed with neutropenic sepsis were coagulase negative staphylococci. Death from sepsis occurred in 10.22% of neutropenic febrile patients. <p> Neutropenic sepsis still remains a therapeutic challenge to achieve desired outcome of chemotherapy in AML. A changed pattern of microbials from gram negative to predominant gram positive organisms in neutropenic sepsis has emerged over last few decades. Encouraging outcome of sepsis management in our set up has favorably compared with that of more ideal ones.

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