Febrile Neutropenia in Hematological Malignancies: Clinical and Microbiological Profile and Outcome

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Febrile Neutropenia in Hematological Malignancies: Clinical and Microbiological Profile and Outcome

Journal Title: GUJARAT CANCER SOCIETY RESEARCH JOURNAL - Year 2018, Vol 20, Issue 1

Abstract

Febrile neutropenia (FN) is considered a medical emergency. Patients with hematological malignancies (HM) commonly experience FN. Broad spectrum antibiotics have to be started empirically to prevent complications. This study attempts to highlight the common infectious agents, their antibiotic sensitivity pattern and outcome in HM like acute myeloid leukemia (AML). Since sporadic data exist from India, this study can be a useful guide for oncologists managing FN in India and building institutional antibiotic policy. In this study, 44 patients with HM, diagnosed and treated for FN episodes with positive blood culture from April 2015 to march 2016 at GCRI, Ahmedabad were analyzed. Blood cultures of patients during febrile episodes were collected from central venous catheters and peripheral blood. Majority of the patients (84%) with FN episodes had absolute neutrophil count (ANC) less than 100/mm3. Eighty four percent patients developed FN between post chemotherapy day 6 to 10. The most common organisms isolated were gramnegative bacilli (80%), with Escherichia coli (48%) being the most frequent pathogen. All Escherichia coli were sensitive to colistin (100%), whereas sensitivity pattern to other antibiotics was as follows: 95%, 50%, 15%, 5% to tigecyclin, amikacin, meropenem, piperacillin-tazoactum respectively. Second most common organisms isolated were Acinetobacterbaumanniiand Klebsiellapneumoniae (14%). Sensitivity pattern of Acinetobacterbaumannii to piperacillin-tazoactum, meropenum, amikacin, levoflox was 100%, 100%, 83%, 16% respectively. Sensitivity of Klebsiellapneumoniae to colistin, tigecyclin, amikacin, meropenum was 100%, 50%, 33%, 16%. Overall mortality was 30%.In AML, there is high risk of developing FN on 2nd week post chemotherapy and when ANC is less than 100/mm3. Most common cause of FN is gram negative septicemia with most common organism is Escherichia coli. Sensitivity of microorganisms to various antibiotics is very predictable. Thus, one can start antibiotic empirically according to institutional sensitivity pattern and then therapy should be tailored to the most appropriate antibiotics according to the bacterial culture results

Authors and Affiliations

Ekta Vala, Harsha Panchal, Asha Anand, Apurva Patel

Keywords

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EP ID EP492286
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