Advanced age is one of the predictors of the development of neutropenic fever in oncology patients. We hypothesize that older cancer patients with age ≥65 years are more likely to have bacteremia during neutropenic episode.
We retrospectively extracted medical records of hospitalized patients between July 2005 and June 2012 with a diagnosis of cancer and febrile neutropenia (Absolute neutrophil count ≤ 1500/µL) at Hurley Medical Center (Flint, MI USA). Using ICD‐9 codes, we obtained the following information: demographic data, type of cancer, catheter type, white blood cell count, absolute neutrophil count, and blood culture. Age of patients was ≥ 19 years. The Chi‐square was used for statistical analysis. Our IRB approved the study.
A total of 81 patients met the inclusion criteria. The age ranged from 19 to 90 years with a mean age of 57.54 ± 14.39 years and median age of 57 years. Fifty‐four of 81 patients (66.7%) were younger than 65 years, while 27 (33.3%) were 65 years or older. Males were 46.3% (25/54) of patient age less than 65 years and 44.4% (12/27) of patient’s ≥ 65 years.
Mean WBC count was 1137 with a range of 100 to 19800 and median of 600. Absolute neutrophil count range was 0 to 1444 with a mean of 335.32 and median of 198.
Fifty‐seven percent (31/54) of patients younger than 65 years had positive blood cultures, while in patients with age ≥ 65 years 44.4% (12/27) had positive blood cultures. Thirty‐one patients age <65 years had 39 isolates with 54% (21/39) gram positive, 44% (17/39) gram negative and 2%(1/39) fungus, while patient ≥ 65 years had 13 isolates with 46% (6/13) gram positive, 46% (6/13) gram negative and 8% (1/13) fungus.
In patients <65 years of age with positive blood cultures, 12.9% (4/31) had MRSA, 6.4% (2/31) E coli, and 6.4% (2/31) pseudomonas isolated. In 65 years or older group, 0% (0/32) had MRSA, 25% (3/12) had E. coli and 8.3% (1/12) had pseudomonas.
Fifty percent (27/54) of patients aged less than 65 years had hematologic malignancy, while 44.4% (12/27) in age group of 65 or older group had the same. Fifty‐seven percent (28/49) of patients <65 years had internal catheter (port) at the time of febrile neutropenia compared to 47.8% (11/23) in patients ≥65 years.
We found a positive correlation between age and WBC (r = 0.244, p<0.05) and between age and ANC (r = 0.256, p<0.05).
We did not find a higher rate of bacteremia including MRSA bacteremia in febrile neutropenic patients ≥65 years of age with malignancy compared to patients with age less than 65 years. We found that patients < 65 years of age have a lower WBC and ANC, more positive blood cultures and MRSA cases compared to older patients (≥65 years). This may be related to the fact that a higher percentage of younger patients had hematological malignancy
To cite this abstract:Mushtaq R, Khan I, Inoue S, Katato K, LaChance J. Are Geriatric Neutropenic Oncology Patients at Higher Risk of Bacteremia?. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 30. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/are-geriatric-neutropenic-oncology-patients-at-higher-risk-of-bacteremia/. Accessed September 16, 2019.