MANAGEMENT OF INFECTIVE COMPLICATIONS IN PATIENTS WITH ADVANCED HEMATOLOGIC MALIGNANCIES IN-HOME CARE

A home care service has been implemented at our center with the aim of offering domiciliary assistance to patients with hematologic malignan cies in advanced phase. We report our experience concerning the home m anagement of these patients in the setting of infective complications. Of 151 patients in home care, 70 (46%) developed a total of 109 febri le episodes, performance status and neutrophil count significantly aff ecting the incidence of infections. Fever was of unknown origin in 51% of cases and microbiologically and clinically documented infections a ccounted for 26 and 23% of the cases, respectively. Oral ciprofloxacin in patients not neutropenic and intravenous ceftriaxone plus amikacin in neutropenic patients was shown to be effective and suitable for em piric home antibacterial treatment; in fact, 65% of febrile episodes r esponded to the initial antibacterial therapy with a further 16% after modification, Overall, 19.3% of the infective episodes were fatal, th e prognosis appearing to be similar to that usually observed in the sa me category of patients in an inpatient setting. Our experience appear s to show that a home care program could be the option of choice for p atients with advanced cancer even in the setting of infective complica tions. It could improve the quality of life of patients and of their f amilies, and it could save these subjects the risk of developing infec tions by resistant nosocomial isolates.