Background:
Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia.
Methods:
A retrospective cohort study (2011-2012) was conducted of patients with high-risk neutropenia in a hematology-oncology service.
Results:
Forty-four episodes of 17 patients with a median age of 48 years (range: 18-78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia iso- lated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%.
Conclusion:
The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (frontline antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol.
Neutropenia Clinical protocols; Hematologic diseases; Gram-negative bacterial infections; Drug resistance; bacterial
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