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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2006

Open Access 01-12-2006 | Research article

Invasive fungal infections in neutropenic enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients

Authors: Marcus Gorschlüter, Ulrich Mey, John Strehl, Volker Schmitz, Christian Rabe, Katharina Pauls, Carsten Ziske, Ingo GH Schmidt-Wolf, Axel Glasmacher

Published in: BMC Infectious Diseases | Issue 1/2006

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Abstract

Background

Neutropenic enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal neutropenic enterocolitis.

Methods

Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal neutropenic enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal neutropenic enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature.

Results

Among 186 articles describing patients with neutropenic enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal neutropenic enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy.

Conclusion

In patients with neutropenic enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in neutropenic enterocolitis.
Appendix
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Metadata
Title
Invasive fungal infections in neutropenic enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients
Authors
Marcus Gorschlüter
Ulrich Mey
John Strehl
Volker Schmitz
Christian Rabe
Katharina Pauls
Carsten Ziske
Ingo GH Schmidt-Wolf
Axel Glasmacher
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2006
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-6-35

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