Background: Febrile neutropenia(FN) is one of the most seroius complications in patients (pts) with haematological malignancies.The prompt initiation of empirical antiboitics within 1 hour of fever has lead to reduction of mortality and improvement of survival .Several risk assesment guidlines have been adopted to identify pts as low and high risk of complications.We conducted this single institution study to determine specific risk factors that may affect the outcome in pts with FN. Aims: To identify specific factors that may affect the response to treatment in pts with febrile neutropenia. Methods: During the peroid of 1st of April 2014 untill the end January 2015, pts with hematological malignancies who presented to clinical oncology department and developed FN during management were enrolled in this prospective analysis . At the onset of fever, pts underwent complete physical examination, in addition to blood culture, urine and stool culture. Computer tomography of the chest and paranasal sinuses and serial galactomannan (GM) test were requested in cases with uncontrolled fever or suspected invasive fungal infection (IFI).Polymerase chain reaction analysis of bacteria and fungi from the blood and bronchoalveolar lavage were performed in selected cases.The data were analysed using chi-square test. Results: One hundred and thirty five (135) pts were identified and analyzed . The mean age was 38.5 years (range 14- 76) . 51% had acute myeloid leukemia, 36% acute lymphoblastic leukemia (ALL), non hodgkin's lymphoma , chronic lymphocytic leukemia , and multiple myeloma were diagnosed in 7% , 4%, and 2% respectively .According to Multinational Association for Supportive Care in Cancer (MASCC) index , 80 pts (60%) were categorised as high MASCC score (<21), while 55 pts (40%) had low MASCC score (>21) . Blood culture was negative in 114 pts (84%), while it was positive in 21 pts(16%) . Gram negative bacteria constituted 60% of cases , while gram positive were 40 %.Serial GM test was positive in 24 pts only (17%),88 pts (65%) did not receive antifungal agents. Fluconazole was used as antifungal prophylaxis in the majority of pts (n=95)(71%), of those who did not receive fluconazole (n=40), only 15 pts (37.5%) developed IFI and were classified according to 2008 European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) Consensus; 12 pts had probable fungal infections,2 pts had possible fungal infections and 1 patient had definitive fungal infection. The choice between first line antibiotics (ceftazidime, maxipime, imipenem) or antifungal (amphotericin, voriconazole) had no impact on the recurrence of FN attacks (P<0.08 and p<0.23 respectively).In terms control of fever on 1st line antibiotics , there was statistically significant difference in favour of low risk MASCC score (p<0.001),change of antibiotics due to uncontrolled fever was required in 62 pts (45%),there was a significant difference between defervescence and low/high MASCC score (P<0.001) .With respect to first antifungal used, a significant correlation was observed between low/high MASCC score and control on first antifungal therapy (P<0.006). In the present study ,16 pts(12%) only were diabetics, there was no significant correlation between diabetes and uncontrolled fever, prolonged neutropenia .Prolonged FN (>7days) was observed in 40% of pts ,the use of corticosteroids , and non administration of granulocyte colony stimulating factor (G-CSF) were the predominant risk factors (P<0.001 ,P<0.002 respectively). In terms of mortality, only pts with high MASCC score(n=11) (8%) had the worst outcome compared to low score(n=1) (P<0.0001). Summary/Conclusion: There are multiple factors that may affect the outcome of pts with FN and it should be taken in considerations during mangment of FN such as MASCC score, previous use of corticosteroid and G-CSF administration during FN
