Abstract
PURPOSE: Sepsis and septic shock in patients with neutropenia are associated with high mortality. We investigated the features and outcome predictors of neutropenic sepsis in the last decade. METHODS: Consecutive patients who were admitted to the intensive care unit (ICU) of a French university-affiliated hospital in 2012-2022, met criteria for sepsis or septic shock, and had neutropenia were included retrospectively. Patient features were collected and compared for 2012-2017 and 2018-2022. Factors associated with hospital mortality were sought by univariate and multivariate analyses. RESULTS: Of the 185 patients, 85 were admitted in 2012-2017 and 100 in 2018-2022. The more recent group was older and had a heavier comorbidity burden but had a hospital mortality rate of 40.0% compared to 49.4% in the early group (p = 0.24). The most common source infections were pulmonary (24.8%) and hepatobiliary or gastrointestinal (23.8%). Gram-negative bacilli predominated. Predictors of in-hospital mortality were older age (odds ratio [OR], 1.04; 1.01-1.07; P = 0.005) and worse SOFA score (OR, 1.22; 1.05-1.42; P = 0.009). Aminoglycoside therapy predicted lower in-hospital mortality regardless of infection site and renal function (OR, 0.30; 0.14-0.63; P = 0.002). Early source-control interventions were not significantly associated with hospital mortality. CONCLUSION: Intensivists are admitting patients with neutropenic sepsis who are older and have more comorbidities than was the case in earlier years. Despite this change, there is a non-statistically significant trend of declining mortality. Our findings support the initiation at ICU admission of combination antibiotic therapy including an aminoglycoside.