Initial empirical antibiotic therapy for neutropenic fever: analysis of the causes of death.

We have reviewed the records of all patients who were included in EORTC-IATCG protocols for the empirical treatment of febrile neutropenia at the Institut Jules Bordet from 1984 to 1994. Of the 410 granulocytopenic patients, 49 died during or after febrile neutropenia. Among these, 19 died from infection, 18 from progressive neoplasia, and 12 from other causes. Fatal bacterial infection occurred in 10 patients and arose during the first 10 days; fatal fungal infection occurred in 7 patients, all of whom had a profound and protracted granulocytopenia (polymorphoneutrophil count < 100/mm3 for more than 20 days). In comparison with a previous similar study (1974-1983) our present observations shows a decrease of overall mortality during or after febrile neutropenia and an increase of gram-positive microorganisms and fungal pathogens as a cause for infectious deaths.