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

Abstract

Background: Because of great concerns about mortality and morbidity of infection in febrile neutropenic patients, the appropriate empirical antibiotic should be started immediately. Although there are established guidelines for the use of empirical therapy, local microbiological pattern and antibiotic susceptibility should be considered. Objectives: The current study aimed to identify the etiological pathogens in febrile neutropenic cancer patients in Isfahan, Iran. Patients and Methods: This single-centre population-based study was conducted on 81 febrile neutropenic patients referring to Sayed-Al-Shohada hospital, the only referral malignant care center in Isfahan, Iran. Demographic data, duration and kind of malignancy, duration from last chemotherapy, duration of fever, and also physical exam were recorded for each patient. Moreover, procalcitonin, CRP, ESR, white blood cells, hemoglobin, platelet, and absolute neutrophil count were measured. BACTEC and E-test were used for blood culturing and determining the antibiotic susceptibility. Results: Out of 81 participants, 28.4% had positive blood cultures which mostly consisted of Gram-positive microorganisms. In addition, Staphylococcus epidermidis was the most isolated Gram positive bacteria (39.1%). ESR, CRP, and procalcitonin were significantly higher in patients with positive blood culture. The risk of infection increased with raise in duration of hospital stay, catheterization, increased pulse rate, increased oral temperature, low level of oxygen saturation, decreased systolic blood pressure, and low absolute neutrophile count. However, in this case, no relationship was found among the patients’ age, diastolic blood pressure, respiratory rate, duration of diagnosis, duration from last chemotherapy, duration of fever, white blood cells, hemoglobin, platelet, and finally the type of malignancies. Conclusions: It was concluded that Gram-positive bacteria were more prevalent as a cause of infection in the patients with malignancy and the most common pathogen was S. epidermidis. Larger studies are needed to determine the bacterial susceptibility of this center.