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J. Clin. Med. 2017, 6(10), 92; doi:10.3390/jcm6100092

History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs

1
Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France
2
Departments of Onco-hematology, Strasbourg University Hospitals, Strasbourg 67000, France
3
Departments of Geriatrics, Strasbourg University Hospitals, Strasbourg 67000, France
4
Departments of Statistics, Strasbourg University Hospitals, Strasbourg 67000, France
5
Regional Pharmacovigilance Centre of Alsace, Strasbourg 67000, France
6
Departments of Rheumatology, Strasbourg University Hospitals, Strasbourg 67000, France
*
Author to whom correspondence should be addressed.
Academic Editor: Paul Huang
Received: 11 August 2017 / Revised: 14 September 2017 / Accepted: 16 September 2017 / Published: 26 September 2017
View Full-Text   |   Download PDF [259 KB, uploaded 26 September 2017]

Abstract

Background: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital. Patients and methods: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg, France). Results: Mean patient age was 52.2 years old (range: 18–93) and gender ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%), neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main clinical presentations upon hospitalization included isolated fever (30%), sore throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%), septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was 0.13 × 10(9)/L (range: 0–0.48). While in hospital, 22 patients (28.9%) worsened clinically and required intensive care unit placement. All patients were promptly treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth factors. Mean duration of hematological recovery (neutrophil count ≥1.5 × 10(9)/L) was 7.5 days (range: 2–21), which was reduced to 0.7 days (range: 2–16) (p = 0.089) with hematopoietic growth factors. Outcome was favorable in 89.5% of patients, whereas eight died. Conclusions: Like in oncology and myelosuppressive chemotherapy settings, idiosyncratic febrile neutropenia is typically serious, about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock, with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia, modern and timely management (immediate broad spectrum antibiotherapy, hematopoietic growth factors) may reduce infection-related mortality. All practitioners should be aware of this potential side-effect that may even occur in the event of “daily medication” exposure. View Full-Text
Keywords: fever; neutropenia; agranulocytosis; drug; infection; hematopoietic growth factor fever; neutropenia; agranulocytosis; drug; infection; hematopoietic growth factor
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Andrès, E.; Mourot-Cottet, R.; Maloisel, F.; Keller, O.; Vogel, T.; Séverac, F.; Tebacher, M.; Gottenberg, J.-E.; Weber, J.-C.; Kaltenbach, G.; Goichot, B.; Sibilia, J.; Korganow, A.-S.; Herbrecht, R. History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs. J. Clin. Med. 2017, 6, 92.

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