PULMONARY INFILTRATIONS IN FEBRILE PATIENTS WITH NEUTROPENIA - RISK-FACTORS AND OUTCOME UNDER EMPIRICAL ANTIMICROBIAL THERAPY IN A RANDOMIZED MULTICENTER STUDY

Background. Different empirical approaches to antimicrobial treatment of lung infiltrates in patients with neutropenia were studied within a prospective, randomized multicenter trial. Methods. Patients with neu tropenia with hematologic malignancies and fever of 38.5 degrees C or higher associated with newly diagnosed lung infiltrates were randomize d for an initial therapy with acylaminopenicillin plus aminoglycoside (Group A), third-generation cephalosporin plus aminoglycoside (Group B ), or the double beta-lactam combination (Group C), each in combinatio n with rifampin. Nonresponders were given empirical amphotericin B plu s 5-fluorocytosine beginning on day 4, day 5, or day 6 under study. Re sults. Of 295 patients entered, 91.2% were evaluable. Complete respons e was obtained in 61.3% with no significant difference between treatme nt groups. The addition of rifampin did not improve treatment results. Only 27.1% of patients achieved a complete response by antibiotic the rapy without additional antifungal therapy. Fungi dominated in cases o f microbiologically documented infections and were associated with a p oorer outcome compared with bacterial pneumonias. The trend of leukocy te counts under study had a highly significant effect on the outcome o f infection. Conclusions. Lung infiltrates in febrile patients with ne utropenia represent a high risk of treatment failure. Persistent neutr openia has a significantly adverse effect on the outcome of infection. Incorporation of systemic antifungal agents into first-line therapy, particularly in selected high-risk subgroups, might improve future tre atment results. The quality of diagnostic techniques to establish the etiology of pulmonary infiltrates needs to be improved.