Analysis of pathogens and susceptibility in cancer patients with febrile neutropenia and bacteremia: Experience in a single institution in eastern Taiwan

Abstract 

Objective

Febrile neutropenia is a major complication in patients with malignancies receiving chemotherapy. The pathogens vary in different geographic areas, however, and also may vary in different institutions. This retrospective study analyzed the profile of bacteria in cases of febrile neutropenia at a single medical center in eastern Taiwan.

Materials and Methods

From July 2006 to July 2007, we retrospectively evaluated 80 adult cancer patients who were admitted to the hematology and oncology ward in our hospital because of febrile neutropenia. The clinical characteristics of those who survived (survival group) and those who died (mortality group) were compared. The blood culture data and susceptibility to antibiotics during episodes of febrile neutropenia were obtained for interpretation.

Results

Among a total of 110 episodes of febrile neutropenia, 31% had documented bacteremia. The most common malignancy among these patients was acute leukemia (31%), followed by non-Hodgkin’s lymphoma and breast cancer. The median time from the start of chemotherapy to febrile neutropenia was shorter in the mortality group than the survival group (8.5 days vs. 11 days; p=0.046). The rate of positive blood cultures was much higher in those who died compared to those who survived (75% vs. 23%, p=0.0001). Gram-negative bacilli were the predominant pathogens in these neutropenic patients, which is different from the trend in Western countries. Infection with Escherichia coli was more common in the survival group and Pseudomonas species were more common in the non-survival group. Gram-positive cocci occurred in similar proportions in both groups. E coli in patients with febrile neutropenia were still susceptible to all first-line antibiotics.

Conclusions

Adult cancer patients with febrile neutropenia are at a high risk of mortality, especially those with documented bacteremia and short times between chemotherapy and neutropenia. Gram-negative bacilli are still the predominant pathogens in patients with febrile neutropenia and most are still susceptible to all first-line antibiotics. Further investigation into the relationship between the patterns of different pathogens and mortality in this population is needed.

Key words: Antibiotics, Bacteremia, Febrile neutropenia