A multi-centre prospective study of febrile neutropenia in Norway: Microbiological findings and antimicrobial susceptibility

Abstract

The urgent need to treat presumptive bacterial or fungal infections in neutropenic patients has meant that initial therapy is empiric and based on the pathogens most likely to be responsible, and drug resistance. The traditional empirical treatment in Norway has been penicillin G and an aminoglycoside, and this combination has been criticized over recent y. We wished to analyse the microbiological spectrum and susceptibility patterns of pathogens causing bacteraemia in febrile neutropenic patients. This was a prospective multicentre study. During the study period of 2 y, a total of 282 episodes of fever involving 243 neutropenic patients was observed. In 34% of episodes bacteraemia was documented. Overall, 40% of the episodes were caused by Gram-positive organisms, 41% by Gram-negative organisms and 19% were polymicrobial. The most frequently isolated bacteria were Escherichia coli (25.6%), a- and non-haemolytic streptococci (15.6%), coagulase-negative staphylococci (12.4%) and Klebsiella spp. (7.4%). None of the Gram-negative isolates was resistant to gentamicin, meropenem, ceftazidime or ciprofloxacin. Only 5 coagulase-negative staphylococci isolates were resistant to both penicillin G and aminoglycoside. The overall mortality rate was 7%, and 1.2% due to confirmed bacteraemic infection.

The Microbiologic Pattern in Pediatric Cancer Patients with Febrile Neutropenia and Bacteremia: A Referral Hospital-Based Study in Northwest of Iran

“…Thus, results were relatively similar except for ampicillin, ceftazidime, and amikacin. Sigurdardottir et al found that 57% of coagulase-negative staphylococci were oxacillin resistant (9). Moreover, no oxacillin resistant S. aureus isolate was observed, whereas, in this study, 88% of coagulase-negative staphylococci isolates and 77.3% of S. aureus strains were oxacillin resistant.…”

A Population-Based Study of Bacterial Spectrum in Febrile Neutropenic Patients

“…In the 70`s, in monomicrobial bacteremia, these bacteria mainly consisted of Gram-negative ones while with the advent of Coagulase-negative staphylococci (CoNS), Viridans streptococci, and Enterococci, this pattern changed to Gram-positive organisms in the 80`s and 90`s (7)(8)(9). In a comparison of febrile neutropenic children with adults, it was demonstrated that 64.2% and 57.9% of isolates were Gram positive in children and adults, respectively (10).…”

Clinical and microbiological characteristics associated with febrile neutropenia

“…Llama la atención el alto porcentaje de óbitos (17,1%) con respecto a estudios realizados tanto en (17)(18)(19) nuestro país como en el extranjero . Este tema debería investigarse a profundidad en estudios prospectivos.…”