The epidemiology of bacteremia with febrile neutropenia: Experience from a single center, 1988-2004

Mical Paul*, Anat Gafter-Gvili, Leonard Leibovici, Jihad Bishara, Itzhak Levy, Isaac Yaniv, Itamar Shalit, Zmira Samra, Silvio Pitlik, Hanna Konigsberger, Miriam Weinberger

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

Background: The epidemiology of bacteremic febrile neutropenia differs between locations and constitutes the basis for selection of emrpiric antibiotic therapy for febrile neutropenia. Objectives: To describe the epidemiology of bacteremia among patients with neutropenia in a single center in Israel. Methods: We conducted a prospective data collection on all patients with neutropenia (< 500/mm3) and clinically significant bactetiemia or fungemia during the period 1988-2004. Results: Among adults (462 episodes) the most common bloodstream isolate was Esherichia coli. Gram-negative bacteria predominated throughout the study period and the ratio between Gram-negative and Gram-positive bacteremia increased from 1.7 to 2.3. Among children (752 episodes), the ratio between Gram-negative and Gram-positive bacteremia reversed from 1.2 to 0.7, due to increasing prevalence of coagulase-negative staphylcoccal bacteremia. Both among adults and children, the length of hospital stay prior to bacteremia had a major impact on the pathogens causing bacteremia and their antibiotic susceptibilities. The prevalence of E. coli decreased with time in hospital, while the rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp., Enterococcus spp. and Candida spp, increased. Resistance to broad-spectrum empiric monotherapy in our center was observed in > 40% of Gram-negative bacteria when bacteremia was acquired aftet 14 days in hospital. Conclusions: Improved infection-control measures for neutropenic cancer patients in our center are needed. Empiric antibiotic treatment should be tailored to patients' risk for multidrug-resistant organisms. Individual hospitals should monitor infection epidemiology among cancer patients to guide empiric antibiotic treatment.

Original languageEnglish
Pages (from-to)424-429
Number of pages6
JournalIsrael Medical Association Journal
Volume9
Issue number6
StatePublished - Jun 2007

Keywords

  • Antibiotic resistance
  • Bloodstream infections
  • Cross-infection
  • Febrile neutropenia
  • Hospital epidemiology

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