Background
Neutropenic enterocolitis (NE) is a life-threatening complication in patients undergoing intensive chemotherapy for hematological malignancies. Aims of this study were to analyze the clinical presentation, diagnostic findings, management and outcome of NE and to explore factors associated with adverse outcome.
Methods
This study describes the presentation and outcome of NE in hemato-oncological patients hospitalized for intensive chemotherapy in the isolation unit of the Infectious Diseases Service at CHUV in 2008 and 2012. Cases were identified from the institutional database and clinical data retrospectively extracted from medical charts.
Results
32 out of 199 hemato-oncological patients (16.1%) presented 35 episodes of NE. According to predefined clinical and radiological/histopathological diagnostic criteria, NE was classified as definite in 14, probable in 19, and possible in 2 cases. Induction or induction-reinduction chemotherapy for acute myeloid leukemia was the most frequent hemato-oncological setting. The triad of neutropenia, fever and digestive symptoms was present in all patients. Bowel wall thickening > 4 mm at CT scan was found in 63.6% of cases. In 34.3% of episodes a bacterial bloodstream infection was documented. Despite a Candida gastrointestinal colonization in more than two thirds of cases, invasive candidiasis was documented in only two cases (5.7%). An adverse outcome was observed in 20% of patients: 4 (11.4%) patients had severe sepsis, two (5.7%) septic shock, 6 (17.1%) were admitted to the ICU, one (3%) underwent an endoscopic intervention and recovered, and two patients died (5.7%): in one (3%) death was attributed to NE. High-dose cytarabine resulting in prolonged agranulocytosis and severe mucosal damage was associated with adverse outcome of NE.
Conclusion
This exploratory study reveals the determinant role of intensive chemotherapy for acute myeloid leukemia and especially of high-dose cytarabine in the occurrence of NE. The severe hematological and mucosal toxicity of this regimen are major components in the pathogenesis of NE and are associated with adverse outcome. These findings may help to identify patients at high risk for complications who need prompt management, close follow-up and maybe antimicrobial prophylaxis.