Research Articles

      Abstract    

        

CAUSES OF NEUTROPENIA AND BACTERIAL INFECTIONS: A RETROSPECTIVE STUDY

E Manuli, J Intra, G Limonta,  P Brambilla

 

ABSTRACT: Neutropenia is characterized by an absolute neutrophil count less than 1,500 cells/µL and an increased risk of infection. Retrospective data of 267 inpatients (cases) with neutropenia and 333 inpatients without neutropenia (normal cases) were consecutively collected from laboratory database of the Italian Hospital of Desio. Subjects with neutropenia caused by chemo- or radiotherapy treatment, myelodysplastic syndromes, chronic liver diseases, and drug-induced had significantly higher rates of infection than normal cases (p < 0.01). Patients whose neutropenia was caused by autoimmune or idiopathic diseases showed no significant differences (p > 0.4). Subjects with neutropenia caused by myelodysplastic syndromes or chemo- or radiotherapy treatment had an increased risk of infections from mild and moderate to severe neutropenia (p trend < 0.0001). Patients affected by myelodysplastic syndromes had a significant shift from urinary to respiratory tract (p = 0.008) and to systemic infections with positive blood cultures (SI+PBC) (p = 0.02) compared to normal cases. Subjects with recent chemo- or radiotherapy treatment presented a significant shift only to SI+PBC (p = 0.01). Collectively, it is important to pay more attention to specific causes of neutropenia and the degree of neutrophils count, which are associated with different risks and sites of the infections.

KEY WORDS: Neutropenia, Infection, Absolute neutrophil count, hematological diseases

REFERENCES:

  1. PE, Dale DC. Evaluation and management of patients with isolated neutropenia. Semin Hematol 2013; 50:198-206.

  2. Legrand M, Max A, Schlemmer B, Azoulay E, Gachot B. The strategy of antibiotic use in critically ill neutropenic patients. Ann Intensive Care 2011; 1:22.

  3. Dale DC, Alling DW, Wolff SM. Application of time series analysis to serial blood neutrophil counts in normal individuals and patients receiving cyclophosphamide. Br J Haematol 1973; 24:57-644.

  4. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966; 64:328-40.

  5. Henry JB, McPherson RA, Pincus MR. Philadelphia:Elsevier/Saunders, 2011.

  6. National Cancer Institute. Common Toxicity Criteria for Adverse Events. Version 4.03. Available at https://www.eortc.be/services/doc/ctc/ctcae_4.03_2010-06-14_quickreference_5x7.pdf

  7. Armitage, P. Tests for Linear Trends in Proportions and Frequencies. Biometrics 1955; 375–86.

  8. Loonen AJ, de Jager CP, Tosserams J et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One 2014; 9:e87315

  9. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med 2013; 33:105-10.

  10. Bozbay M, Ugur M, Uyarel H et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in infective endocarditis: in-hospital and long-term clinical results. J Heart Valve Dis 2014; 23:617-23.

  11. Dogruel F, Gonen ZB, Gunay-Canpolat D, Zararsiz G, Alkan A. The Neutrophil-to-Lymphocyte ratio as a marker of recovery status in patients with severe dental infection. Med Oral Patol Oral Cir Bucal 2017; 22:e440-5.

  12. Minemura M., Tajiri K., Shimizu Y. Systemic abnormalities in liver disease. 2009; 2960-2974. Review.

  13. Boxer LA. How to approach neutropenia. Hematology Am Soc Hematol Educ Program 2012; 2012:174-82.

  14. F, Calvillo M, Bonanomi S, Coliva T, Tucci F, Farruggia P, et al. Congenital and acquired neutropenia consensus guidelines on diagnosis from the Neutropenia Committee of the Marrow Failure Syndrome Group of the AIEOP (Associazione Italiana Emato-Oncologia Pediatrica). Pediatr Blood Cancer 2011; 57(1):10-7.

  15. Lindqvist H, Carlsson G, Moell J, Winiarski J, Sundin M. Neutropenia in childhood: a 5-year experience at a tertiary center. 2015; 801-7.

  16. CL, Tesfa D, Siersma VD, Sandholdt H, Hasselbalch H, Bjerrum OW, et al. Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study. JIM 2016; 279(6):566-575.

  17. Puri S, Bery A, Sekhon JS, Amandeep. Pattern of Infections in patients with Neutropenia and their Outcome. JIMSA 2010; 23: 219-21.

  18. Naumenko V, Turk M, Jenne CN, Kim SJ. Neutrophils in viral infection. 2018; 505-16.

  19. Rolston KV. Infections in Cancer Patients with Solid Tumors: A Review. Infect Dis Ther 2017; 6(1):69-83.

  20. Tancheva S, Micheva I, Marinova I, Bojchev B, Marinov M, Nenov K, et al. Infection in urinary tract of patient with hematological malignancies undergoing anti-neoplastic therapy. 2009;95-7.

  21. Sandoval C, Sinaki B, Weiss R, Munoz J, Ozkaynak MF, Tugal O, et al. Urinary tract infections in pediatric oncology patients with fever and neutropenia. 2012; 68-72.

  22. Oude Nijhuis CS, SM, Vellenga E, van der Graaf WT, Gietema JA, Groen HJ, et al. Fever and Neutropenia in Cancer Patients: The Diagnostic Role of Cytokines in Risk Assessment Strategies. 2002; 163-74.

  23. Purewal SS Singh RP, Kahlon R.S. Study of Bacterial Pathogens and Viral Infections in Neutropenic Cancer Patients. 2011; :15-22.

  24. T, Pène F. Current insights into severe sepsis in cancer patients. Rev Bras Ter Intensiva 2014; 26(4):335-8.

  25. Gustinetti G., Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence 2016; 7(3): 280–297.

  26. Dayyani F, Conley AP, Strom SS, Stevenson W, Cortes JE, Borthakur G, et al. Cause of death in patients with lower-risk myelodysplastic syndrome. 2010; (9):2174-9.

  27. Latagliata R, Niscola P, Aloe Spiriti MA, Carmosino I, Cesini L, Sarlo C, et al. Pulmonary Infections in Patients with Myelodysplastic Syndromes Receiving Azacytidine Treatment. 2016 128:5544.

  28. G, Pagano L. Infections in Myelodysplastic Syndrome in Relation to Stage and Therapy. Mediterr J Hematol Infect Dis 2018; 10(1):e2018039.

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