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KMID : 0984720060380050250
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Infection and Chemotherapy
2006 Volume.38 No. 5 p.250 ~ p.258
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Clinical Manifestations of Febrile Neutropenic Patients with Solid Tumor and Risk Ractors for Gram Positive Bacteremia
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Ku Nam-Su
Kim Jun-Hyung
Choi You-Kyoung
Jung Se-Jin
Oh Hyung-Jung
Youn Ki-Tae
Kim Yeon-A
Shin So-Youn
Kim Myung-Soo
Kim Young-Keun
Park Yoon-Sun
Choi Jun-Yong
Song Young-Goo
Lee Kyung-Won
Kim June-Myung
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Abstract
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Backgrounds : Recently, there has been a rise of prevalence of gram positive infection among
cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection
has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It
brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram
positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients
were mainly related to hematologic malignancy rather than solid tumor.
Materials and Methods : We evaluated clinical manifestations and risk factors for gram positive
bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had
neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of
Oncology, Yonsei Cancer Center, Seoul.
Results : We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were
blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of
blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic
regression analysis revealed that gram positive bacteremia was associated independently with central
venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile
neutropenic patients with solid tumor.
Conclusions : Gram positive bacteremia was common among febrile neutropenic patients in solid
tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection.
The early use of glycopeptide must be taken into account in such conditions.
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KEYWORD
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Solid Tumor, Febrile Neutropenia, Gram Positive Bacteremia, Clinical Manifestations, Risk Ractors
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