Evaluation of the effects of nursing interventions in patients with neutropenic fever entered into the prospective study of empiric antibiotic therapy
Authors: Zivkovic Dusanka , Jovanovic Verica , Radosavljevic Biljana 
Published: March 2009

Background: Febrile neutropenia (FN) is a potentially lethal complication of severe neutropenia induced mainly by chemotherapy. The treatment of FN is one of the most important fields in supportive therapy in cancer patients. We evaluated the effects of health care measures in patients with FN entered in randomized prospective study of the two empiric antibacterial regimens Cefoperazone versus the combination of cefoperazone and amikacin. All patients were admitted in the Oncology Intensive Care Unit for the treatment of FN and intensive monitoring. This study is currently ongoing in cooperation with the Department for Medical Oncology, from which patients are recruited into the study. The objective of this report is to show the importance of nursing interventions in health care of patients with FN for Timely recognition of neutropenia, prevention of infections in neutropenic patients, prompt reaction in urgent conditions of FN and infection, and effective treatment of neutropenia. Patients and methods: From February 2001 to May 2003, 483 patients with grade 4 neutropenia (according to the WHO criteria) were registered at the Department of Medical Oncology. Eighty of these patients were entered into the study, 39 patients were treated with cefoperazone alone (group A), and 41 patients with the combination of cefoperazone and amikacin (group B). The data about planned nursing interventions were collected from the health care plan. Nursing interventions serving in prevention of development of FN in severely neutropenic patients are as follows: Everyday check-up, the control of body temperature every 6 hours, the observation of patients and monitoring for symptoms and signs of infection, and detailed inspection of patients (exposed spots risky for infection, oral mucous membrane, intravenous spots catheters, wounds), control of drugs which patient takes (some of them can mask signs and symptoms of infection), control of patient's personal hygiene. Nursing interventions performed during the period of FN are as follows: Continual check-ups, control of vital functions every 6 h, and more frequently, as needed, 2 samples of hemoculture for aerobes and anaerobes within 30-minute period, urinoculture, smears of skin lesions and of oral mucus. As neutropenic patients are very often at high risk for severe stomatits, identification of its symptoms and aseptic care of oral cavity are very important nursing interventions directed toward prevention of the development of stomatitis and its complications. Results: Two hundred and forty eight out of 483 patients with severe neutropenia (51,3%) developed FN. Eighty patients of them entered our clinical study. The median duration of severe neutropenia for a group of 39 patients treated with cefoperazone alone was 5 days, while median duration of FN was 4,4 days. In 41 patients treated with cefoperazone and amikacin, the median duration of neutropenia grade 4 was 6 days, and the duration of FN was 4 days. Documented clinical infections in both groups of patients are presented on Table 1. In 7 and 14 patients in groups A and B, respectively urinoculture was positive. Furthermore, hemoculture was positive in 8 patients in both treatment arms. Nine patients developed stomatitis grade 1 and grade 2, without further complications. Conclusion: Our results reveal the substantial contribution of nursing health care in neutropenic patients and those with FN in preventing and in time treating these complications.