From January 1979 to March 1985, febrile episodes occurring in 35 aged patients (maen age 76 years old) with leukemia were reviewed. There were 2.2 febrile episodes per patient on an average. Eighty-two percent of the febrile episodes was due to documented infections. The most common types of infections were septicemia and pneumonia, which together accounted for 61% of the total infections.
Causative microorganisms were identified in 59% of the total febrile episodes. Gram-negative bacilli were responsible for only 46% of the microbiologically documented febrile episodes, while 40% of episodes was caused by gram-positive cocci. The use of new broad-spectrum antibiotics seems to have increased the frequency of gram-positive-cocci infections. Twenty-nine percent of the patients had repeated episodes of infections caused by the same organisms.
As has been generally pointed out about the infection in the aged, infections caused by multiple organisms were very frequent. The most common combination, gram-positive cocci and gram-negative bacilli, accounted for 64% of these infections.
Sixty-seven percent of febrile episodes occurred when the patients had neutropenia (less than 500/mm3), while 29% of the episodes occurred when the patients had enough neutrophils (more than 1,000/mm3). The fatality rate during febrile episodes was higher when the patients had neutropenia. The longer the duration of severe neutropenia (less than 100/mm3), the higher the susceptibility of febrile episodes was observed.
Disseminated intravascular coagulation (DIC) occurred in 21 patients during the follow-up period, 80% of which was related to febrile episodes. The fatality rate for infections complicated by DIC was 82%.
