Assessment of Microbial Etiology of Febrile Neutropenia

Abstract

Bacterial and fungal infections are a leading cause of morbidity and mortality in neutropenic patients. The empiric antimicrobial regimen is chosen based on the susceptibility pattern of locally prevalent pathogens. Blood and other clinical specimens from 64 febrile neutropenic patients with clinical sepsis have been processed to ascertain the bacterial and fungal spectrum and antimicrobial susceptibility pattern. A case-control study was used to identify risk factors for developing sepsis.

A total of 68 organisms were recovered. Fifteen (22.05%) were Gram-positive cocci with predominance of methicillin Sensitive S. aureus (10.29%), 47 (69.11%) were Gramnegative rods with predominance of Klebsiella pneumoniae (30.88%) and four were Non albicans Candida. 81% and 60% of Klebsiella and E. coli were ESBL producers. All species of Candida were sensitive to amphoterecin B and voriconazole. The duration and severity of neutropenia, chemotherapy, immunosuppressive therapy, altered mucosal barriers, and the existence of central venous lines were all statistically significant risk factors for developing sepsis. Gram-negative bacteria were the most prevalent isolates. Amongst the fungal isolates, non-albicans candida spp. were predominant. The selection of therapy for neutropenic patients should be based on the local spectrum of microbes as well as local and regional resistance patterns.