Analysis of infections in oncological patients with febrile neutropenia: integrative review

Abstract

Febrile neutropenia (FN) is a frequent complication in patients undergoing chemotherapy, characterized by fever — defined as an oral temperature ≥ 38.3 °C or two consecutive measurements ≥ 38.0 °C at other body sites — combined with an absolute neutrophil count below 500 cells/mm³. This condition substantially increases the risk of severe infections and may compromise the continuity of antineoplastic treatment. This study aimed to describe the main infections in oncologic patients with febrile neutropenia, consolidating epidemiological and microbiological information. An integrative literature review was conducted, including articles published between 2013 and 2023, available in full text in PubMed, Scopus, Web of Science, ScienceDirect, and the Virtual Health Library. Studies presenting quantitative or qualitative data on the etiological profile of infections and related risk factors were selected. The analysis showed that bacterial infections represent the majority of FN episodes, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa being the most frequent Gram-negative bacilli, and Staphylococcus coagulase-negative and Streptococcus viridans the most common Gram-positive cocci. Fungal infections caused by Candida spp. and Aspergillus spp. were observed mainly in patients with prolonged neutropenia. Viral infections, though less prevalent, were also reported, including cytomegalovirus reactivation and viral hepatitis. It is concluded that the characterization of infections in patients with FN contributes to the epidemiological understanding of the condition, supports microbiological surveillance, and provides a basis for future research aimed at preventing infectious complications.