Epidemiology of Febrile Neutropenic and Bacteremic Patients in the Extensively Drug-Resistant Era

Abstract

Background: Appropriate empiric antibiotic use is of utmost importance in febrile neutropenic patients. This study analyzed positive blood culture reports from febrile neutropenic patients and provided a new empirical antibiotic treatment approach. Methods: This study retrospectively enrolled febrile neutropenic patients with hematological or solid organ malignancies who had positive blood cultures at the Bahrain Oncology Center within January 2019 to August 2021. Microbiological data were used to draw inferences for rational antimicrobial treatment. The quick sequential organ failure assessment (qSOFA) score was employed to classify the severity status. The t-test was used to compare univariate and multivariate sensitivity values for two dependent proportions. Results: A total of 73 episodes of bacteremia were detected in 53 patients. Among these, 54 episodes (74%) were caused by gram-negative organisms. The most commonly isolated organisms were Escherichia coli (30%), Klebsiella pneumonia (22%), and coagulase-negative staphylococci (11%). The rate of extensively drug-resistant strains among K. pneumoniae was 44% (n = 7). Among gram-negative microorganisms, the susceptibility rates for monotherapies were reported for ceftazidime (56%), piperacillin/tazobactam (76%), cefepime (54%), meropenem (80%), and ceftazidime-avibactam (91%). The susceptibility rates for tigecycline-based combinations exceeded 90% overall. Conclusions: Clinical severity and local epidemiological data should be considered in the management of febrile neutropenia. New antibiotics and tigecycline should be considered for combination therapy in selected cases due to the increasing resistance observed.