Antibiotherapy of febrile neutropenia among patients with cancer admitted at the intensive care unit: a retrospective study

Febrile neutropenia (FN) is a medical emergency requiring immediate evaluation and administration of empiric broad-spectrum antibiotics. In cancer patients, it’s a major cause of morbidity, mortality, and overcost. Our retrospective study over a period of 1year described epidemiology, bacteriology, antibiotherapy and prognostic of FN in cancer patients admitted at intensive care unit (ICU) of Rabat Oncology National Institute (Morocco).We first ranked FN among all reasons of hospitalization at ICU, then we described epidemiology, management and prognosis. Over the studied period, 520 patients were admitted at ICU (74% for surgical reasons and 26% for medical ones). FN represents 34% among all reasons for hospitalization at ICU. Antibiotherapy was empiric in 70% of patients. For the first-line, it was based on ceftazidim or imipenem-cilastin. For the second-line, ceftazidim or imipenem were associated to amikacin or gentamicin. For documented antibiotherapy, targeted germs were Staphylococcus spp(37,5%), E.coli(25%), Streptococcus spp (16,7%), P.aeroginusa (8,3%), A.baumanii(8,3%) and K.pneumonia (4,2%).

Death was observed in 20% of FN patients, which represents 19% of total death at ICU over the study period. To sum up, FN is a common, resource‐intensive and clinically important complication of cancer treatment. Despite an antibiotic therapy started in all our patients with FN, evolution remains fatal for 20% of patients.