2677. Infection-Related Outcomes in Patients With Malignancy-Related Febrile Neutropenia: A National Perspective

Abstract

Abstract Background Febrile neutropenia (FBN) is a life-threatening oncological emergency requiring hospitalization and early treatment with broad-spectrum antibiotics. We aimed to study differences in infection-related outcomes for febrile neutropenia in various malignancies. Methods The National Inpatient Sample (NIS) data set was queried from 2007 to 2014 to identify all patients with a diagnosis of neutropenic fever (ICD-9: 780.6x and 288.5x or 288.0x or 284.1x). Diagnoses for various cancers were determined via their respective Clinical Classification Software (CCS) codes. Diagnoses of pneumonia (481.x, 482x), bacterial meningitis (320.x), Clostridium difficile (008.45), infectious colitis due to neoplastic agents (009.x), urinary tract infection (599.0x), pyelonephritis (590.1x, 590.80), skin and soft-tissue infection (682.x, 684.x, 686.8x, 686.9x), mucositis (528.01), influenza (CCS 487), sepsis (995.91), severe sepsis (995.92), septic shock (785.52), E. coli septicemia (038.42), Pseudomonas septicemia (038.43), MRSA septicemia (038.12) and Streptococcal septicemia (038.0) were identified using their respective ICD/CCS codes. Variables were analyzed via multivariate analysis using the program SAS. Results We studied 381,043 patients with FBN. Leukemia was the most common malignancy associated with FBN (140,190, patients, 36.8%). Meningitis was found to be significantly associated with brain cancer, while other infections were associated with a range of malignancies. (Table.1) Methicillin-resistant Staphylococcus aureus was associated with cancers of the bone, breast, uterus and non- hodgkins lymphoma, while other microorganisms varied across different malignancies (Table 2). Septic Shock was associated with cancer of the pancreas, lung, bone, breast, leukemia, bladder, kidney, thyroid, myeloma, prostate, testis, cervix, brain, melanoma, non-hodgkins lymphoma, compared with other malignancies (Table 3). Conclusion Pathogen-specific and targeted antibiotic therapy is the cornerstone of treatment in FBN. Our study provides evidence of specific presentations and organisms causing infections in various malignancies. We hope that further outcomes-based research will provide objective evidence of certain high-risk infections, improving patient outcomes and minimizing redundant testing. Disclosures All authors: No reported disclosures.