Febrile Neutropenia in Cancer Patients: Microbiology and Empirical Antibiotic Therapy

This study was conducted to evaluate the empirical antibiotic therapy for febrile neutropenic patients, patterns of bacterial isolates and their drug resistance. Method: It was a retrospective study; data of the patients admitted to the university hospital from 1/1/2010 to 1/6/2012 was evaluated retrospectively. ICD-10 for Cancer patients was used to locate the HN of oncology patients. Then Data for all of these patients was reviewed according to our inclusion criteria to select our sample population. Results: A total of 272 microorganisms were isolated during the study period. Gram-negative bacteria accounted for 73.5% of organisms, while gram-positive organisms accounted for 21.6% of the total isolates. Ninety-three (48.9%) episodes were found to have inappropriate empirical antibiotic therapy. Bacterial isolates of 40 episodes were found to be resistant against the prescribed therapy, which is the 43.0% of the all episodes identified with inappropriate therapy. Thirty episodes (32.25%) were found to have delay in the empirical therapy and for remaining 23 episodes 24.73%, no fungal therapy was prescribed after continuous episode of febrile neutropenia for 7 days. Conclusion: Gram-negative organisms are the predominant organisms in adult febrile neutropenic patients at our institute. Initial empirical therapy with piperacillin/tazobactam seems appropriate to cover most gram-negative pathogens, but considering high resistance of Klebsiella pneumoniae, other antipseudomonal b-lactam agent with no resistance should be considered.If fever does not settle after 4-7 days of antibiotic treatment, anti-fungal therapy should be added.