Outcomes and microbiological patterns of bacteremia in chemotherapy-related febrile neutropenia at a tertiary facility in Kenya.

Abstract

Introduction: Febrile neutropenia (FN) is a major cause of mortality and morbidity in patients with malignancy post-chmotherapy. Current guidelines for managing FN recommend starting empiric antibiotic therapy (EAT) promptly. The choice of antibiotic is based on the patient's condition, local data on common microorganisms isolated, and their resistance patterns. Of note, there is a growing trend of isolating multi-drug-resistant gram-negative bacteria in these patients. In sub-Saharan Africa, there are insufficient data on the mortality rates of FN. There is also a lack of local epidemiologic data on the frequently isolated microorganisms and their antibiotic resistance patterns. This makes it challenging to determine the appropriate EAT for patients with FN. This study aimed to determine the mortality rates of FN in patients with cancer and characterize the isolated microorganisms and their resistance patterns.

Methods: This was a retrospective descriptive study of adult patients with cancer hospitalized with FN post-chemotherapy between January 2017 and July 2022 at Aga Khan University Hospital, Kenya. Continuous variables are expressed as medians with inter-quartile ranges whereas categorical variables are expressed as frequencies and percentages.

Results: A total of 90 episodes of FN involving 50 unique patients were identified from medical records. The median age was 42.8 years (inter-quartile range: 31.3-65.0). Male patients accounted for 67.0% (n = 60). Hematologic malignancies accounted for 90.0% (n = 81). The mortality rate was 26.0% (n = 13), with 84.6% (n = 11) having a hematologic malignancy. Of the 90 episodes, 27.8% (25) had positive blood cultures; 68.0% (17) were gram-negative, 24.0% (six) were gram-positive, and 8.0% (two) were candida species. Klebsiella pneumoniae was the most common bacteria isolated. Among gram-negative bacteremia, 23.5% (four) were third-generation cephalosporin-resistant and 11.7% (two) were carbapenem-resistant.

Conclusions: The study found a higher mortality rate in patients with FN in East Africa than in North America. Gram-negative bacteria were the most commonly isolated pathogens in blood cultures, with a growing concern over the increasing prevalence of multi-drug-resistant strains. Further multi-centered studies involving larger sample sizes are required to help develop regional guidelines for the choice of EAT in the management of FN.