To identify the risk factors and attributable mortality associated with superinfections in febrile neutropenic patients with hematologic malignancies, we prospectively evaluated 333 episodes of fever and neutropenia by means of univariate and multivariate analyses. Superinfection was defined as any infection either occurring during antibiotic therapy or developing within 1 week after discontinuation of antibiotic therapy. Of 333 episodes, 46 (13.8%) were defined as superinfection; these

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... occurred in 46 patients. The risk factors for superinfection in the multivariate analysis were longer duration of profound neutropenia (P < .0001), lack of use of quinolones as prophylaxis (P < .0001), presence of a central venous catheter (P = .02), and persistence of fever after 3 days of antibiotic therapy (P = .02). The crude mortality rate among patients with superinfection was 48%, and the attributable mortality rate was 24% (95% confidence interval, 3%-45%). Identifying risk factors for superinfections in neutropenic patients might allow clinical practices to reduce the negative impact of this complication. The management of infectious complications in neutropenic patients with cancer has improved substantially in the past two decades. The high mortality rate associated with bacteremias due to gram-negative organisms has decreased with the introduction of empirical antibiotic therapy and the development of new antibiotics [1]. In addition, major progress has been made in the treatment of malignant diseases, including the use of more aggressive chemotherapeutic regimens, intravascular catheters, and bone marrow transplantation. Consequently, more prolonged periods of neutropenia and new risk factors are anticipated. For example, high doses of cytarabine therapy are associated with severe mucositis, thus predisposing patients to infection by streptococci [2], and the use of central venous catheters is associated with bloodstream infections due to gram-positive organisms and fungi [3]. Furthermore, the widespread use of antimicrobial agents as prophylaxis and empirical treatment probably influences the emergence and spread of resistant microorganisms [4]. Therefore, the better control of early infections in neutropenic patients by means of empirical antibiotic therapy associated with these risk factors may increase the frequency of superinfection. It is known that secondary nosocomial bloodstream infections are associated with higher mortality rates [5]. However,