538P Blood cultures in febrile neutropenic patients with cancer

Abstract

Background Infection remains an important cause of morbidity and mortality in cancer patients. The most troubling infection in neutropenic patients is blood stream infection. The aim of this study is to determine the number of these febrile episodes with a positive blood culture and define the type of infections. Methods In this observational study over a 12-month period, from September 2014 to 2015, all patients with cancer, fever and neutropenia admitted to our hospital were included. Their medical records were reviewed. All statistical analyses were performed using SPSS. Results Seventy patients entered the study; 40 (57%) were male and 30 (43%) female. Of the 70 patients, there was no positive result for blood cultures. Their median age was 52 years (14-90 years). The most common tumors were GI cancers (41.42%). Prevalence of cancer of head and neck, breast, genitourinary, lung, in our patients were 34%, 10%, 8.14%, 6.71%, respectively. 54% of them (38 patients) were classified as fever of unknown origin, and diarrhea is the most common symptom. Median time to afebrile state was 2 days. The most commonly used empiric antibiotics were imipenem/ meropenem +/- vancomycin/ciprofloxacin. 62.4% of patients received two antibiotics, 37.6% of them three or more antibiotics. Only three patients had received G-CSF before admission. Five patients underwent chemoradiation. Seven patients died. Conclusions Our study showed no positive blood cultures in comparison with other findings in the world that shows bacteremia occurs in 10%–25% of febrile neutropenic patients. It seems that one reason for such results might lie in inefficient blood culture techniques and lack of appropriate laboratory instruments. Critical situation makes starting empiric antibiotic treatment mandatory and this may be the most probable reason for having negative blood cultures in infected patients. A second reason may be receiving antibiotics before arriving in hospital. For true blood culture results and to lessen the cost of therapy, use of an automated blood culture system as an urgent tool, and giving more information to cancer patients about this critical situation is reasonable. Because of the higher risk of bacterial infections in these patients, it is important to know the more prevalent pathogens and the sensitivity of them to different antibiotics in these patients. Legal entity responsible for the study Ethics Commitie of Shahid Beheshti University of Medical Sciences Funding Clinical Oncology Group of Shahid Beheshti University of Medical Sciences Disclosure All authors have declared no conflicts of interest.