E-Charts help track course of febrile events in hematology

Computerized registry could be easily adopted in the U.S., according to Italian developers.

Developing a web-based registry among community oncologists may be useful for collecting significant information about febrile events in patients with hematologic malignancies. Italian researchers have suggested that both morbidity and mortality could be lowered in this patient population through a computerized registry that collected data in a prospective manner.

“We have developed what may be the first web-based registry to collect febrile events in hematologic malignancy patients so you can register a real-life picture of what is occurring in these patients,” said study investigator Morena Caira, MD, a research scientist at the Catholic University in Rome.

Dr. Caira said developing such a system has allowed oncologists in Italy to create a complete system for the epidemiological study of infectious complications in this cancer patient population. It is a simple system that could be adopted in the U.S. on a community- wide, state-wide, or country-wide basis, she said.

“We need to know better what is causing febrile events so that we can reduce the use of antimicrobials that are unnecessary,” said lead investigator Livio Pagano, MD, an associate professor of hematology in the department of epidemiology at Catholic University.

Dr. Pagano and Dr. Caira presented their findings on the Hema e-Chart at the 2010 Interscience Conference on Antimicrobial Agents and Chemotherapy meeting. The Hema e-Chart is a computerized registry that prospectively collects data to analyze febrile events in hematologic malignancies, assesses the number and causes of febrile events, and offers possible outcomes due to different causes.

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The researchers analyzed data on all febrile events in a cohort of adults with hematologic malignancies who were admitted to 17 hematology/oncology departments in Italy from December 2006 through March 2009. The study population included 2,681 patients with hematologic malignancies, including acute and chronic leukemia, lymphoma, myeloproliferative disorders, and myelodysplastic syndromes, treated with conventional chemotherapies. A total of 725 febrile events were documented in 539 patients.

The researchers found that febrile unidentified origin (FUO) was the most frequently detected (315 cases; 43%). The cause of the febrile events was identified as noninfectious in 34 cases (5%) and infectious in 376 cases (52%). Dr. Pagano said bacterial infections were the most common cause of febrile events (252 cases), followed by fungal infections (87 cases) and viral infections (six cases).

The researchers found that mixed organisms were isolated in 31 febrile events (see Table). Only 50 febrile events were reported as the cause of death, and those cases represented an incidence of 1.8% in the whole population of 2,681 patients. The attributable mortality rate was found to be 6.8% (50/725 febrile events). Dr. Pagano said no deaths were observed in patients found to have viral infections or noninfectious causes of febrile events. However, 16 deaths were reported to be due to FUO, 17 to bacterial infections, 14 to fungal infections, and three to fungal/bacterial infections (abstract K-1714).

“We want to avoid using antibiotics that are not helpful and may be contributing to multidrug resistance,” Dr. Pagano told Oncology News International. “This type of registry can give us a better idea of what is happening. This is done prospectively; it is not a retrospective series and so there are no record biases or other statistical biases.”

He said by looking at large numbers of patients, individual providers can get a better idea of what is happening in their region. He said that this can allow clinicians to learn from each other and subsequently avoid some of the mistakes that other clinicians may experience in treating febrile events.

VANTAGE POINT

This type of registry is a very good idea and should be adopted in the U.S., said Dr. Prelutsky, an associate professor of clinical medicine at Washington University School of Medicine in St. Louis. This approach to treating febrile events could help lower morbidity and possibly help combat problems with multidrug resistance, he said, adding that the sooner this type of system is put in place in various communities, the better.

“Infectious complications are a major source of morbidity and mortality in hematologic malignancies. I think a febrile event registry is a good idea, especially locally, as it can give clinicians in each community a snapshot of the etiologies of febrile events in their area. Thus, the clinician would be better armed as to which pathogens to suspect, and could begin empiric therapy more appropriately,” Dr. Prelutsky said.