Clinical and Microbiological Profile of Pathogens in Febrile Neutropenia in Hematological Malignancies: A Single Center Prospective Analysis

Abstract

Background. Febrile neutropenia is the consequence of treatment of hematological disorders. The first-line empirical treatment should cover the prevalent microorganism of the institute. The aim of study was to establish the effectiveness of current practices used at the institution and to review the culture sensitivity pattern of isolated microorganisms. Patients and Methods. Data was recorded and analyzed prospectively for 226 hospitalized patients of febrile neutropenia from January 2011 till December 2013. Results. Out of 226 cases, 173 were males and 53 were females. Clinically documented infections were 104 (46.01%) and microbiologically documented infections were 80 (35.39%), while 42 (18.58%) had pyrexia of undetermined origin. Gram negative infections accounted for 68 (85%) and Escherichia coli was the commonest isolate. Gram positive microorganisms were isolated in 12 (15%) cases and most common was Staphylococcus aureus. First-line empirical treatment with piperacillin/tazobactam and amikacin showed response in 184 patients (85.9%) till 72 hours. Conclusion. There is marked decline in infections due to Gram positive microorganisms; however, Gram negative infections are still of great concern and need further surveillance. In this study the antibiogram has shown its sensitivity for empirical antibiotic therapy used; hence, it supports continuation of the same practice.

Infections in patients with lymphoma: An analysis of incidence, relationship and risk factors

“…Bacteriological data revealed that Gram-negative infections accounted for 92.3% and E. coli was the most common isolate. This finding was consistent with many other trials which have reported that E. coli is still the most frequently isolated Gramnegative organism in hematological malignancies [7][8][9][10][11]. The antibiotic treatment prior to taking blood cultures may be considered a reason for the lower rates of isolation of bacteria, since half of the E. coli cases among MDI were MDR strains.…”

“…In the current study, total MDI in IE were 13 (20%) and FN were 4 (10.8%). This rate was slightly lower than in previous studies that have reported microbiological confirmation of BSI in only 15% to 43 % of cases of FN [7][8][9][10]. Bacteriological data revealed that Gram-negative infections accounted for 92.3% and E. coli was the most common isolate.…”

Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection

“…Despite a diagnostic focus on bacteremia and concern about resulting clinical sepsis, microbiological confirmation of BSI only occurs in 15% to 35% of cases of FN, and reported in-hospital mortality ranges from 3 to 39% [3, 4, 9]. This wide range is attributable, in part, to the emerging challenge of multi drug-resistant organisms in some populations, particularly the gram-negative bacteria [10].…”

Phenotypic and molecular characterization of inducible clindamycin resistance among Staphylococcal strains isolated from cancer patients with febrile neutropenia

“…This study performed on 231 cases of febrile neutropenia from which Staphylococcus aureus could be isolated from 179 (77.4%). On reverse to this work, a study performed by Taj et al (2015) found that Gram negative infections accounted for 68 (85%) and Escherichia coli was the commonest isolate. Gram positive microorganisms were isolated in 12 (15%) cases and most common was S. aureus.…”

“…This study reported only one staphylococcus isolate (1%) with constitutive clindamycin resistance; resistant to vancomycin and 12 strains with inducible clindamycin resistance (12%) were resistant to vancomycin. Taj et al (2015) also reported that the commonest Gram positive isolate is S. aureus and 4 cases of MRSA were isolated: all were sensitive to vancomycin; however, 2 cases of vancomycin resistant enterococci (VRE) were documented and were treated successfully with linezolid. In this study, sputum samples represents 26%, pus and urine 18.4 and 18.4% respectively, throat swab 19.4%, blood 17.3% of the clinical samples of cancer patients febrile neutropenia.…”