Trends and antimicrobial resistance of pathogens causing bloodstream infections among febrile neutropenic adults with hematological malignancy.
OBJECTIVE
The microbiological spectrum in cancer patients with febrile neutropenia has changed over the past several decades in western countries. The growing incidence of antimicrobial resistance is an inevitable consequence of the widespread use of antibiotics in medical settings. The aim of this study was to clarify the trends and antimicrobial resistance among pathogens causing bloodstream infections in febrile neutropenic adults with hematological malignancies.


METHODS
The characteristics of pathogens causing bloodstream infection isolated from patients with febrile neutropenia who were treated at National Taiwan University Hospital from 1996 to 2001 were reviewed. A total of 1174 pathogens were isolated from 3093 admissions to a hematological ward during this period. Among them, 738 isolates were recovered from patients with febrile neutropenia.


RESULTS
The majority (93%) of these neutropenic febrile patients had underlying acute leukemia or lymphoma. Gram-negative bacteria accounted for 57% of isolated pathogens, followed by Gram-positive bacteria (32%), fungi (7%), and anaerobes (3%). In decreasing frequency, Escherichia coli (13%), Klebsiella pneumoniae (12%), Enterobacter cloacae (7%), Pseudomonas aeruginosa (6%), and Acinetobacter baumannii (5%) were the predominant Gram-negative bacteria, while coagulase-negative staphylococci (13%), viridans group streptococci (4%), and Staphylococcus aureus (4%) were the major Gram-positive pathogens. Two-thirds (20/30) of S. aureus isolates were resistant to oxacillin. No vancomycin-resistant enterococci were isolated. Resistance to cefotaxime was found in 63% of E. cloacae, 13% of K. pneumoniae and 10% of E. coli. Overall, 33% of E. coli and 13% of K. pneumoniae were resistant to ciprofloxacin.


CONCLUSIONS
This study indicates that the microbiological spectrum of microorganisms causing bloodstream infections in neutropenic febrile patients with hematological malignancies at National Taiwan University Hospital is different from western countries in that Gram-negative bacteria remain the predominant pathogens. Antimicrobial resistance among these pathogens is high and E. coli and K. pneumoniae isolates with resistance to third-generation cephalosporins and ciprofloxacin are increasing.
Chen
Chien-Yuan
CY
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei.
Tang
Jih-Luh
JL
Hsueh
Po-Ren
PR
Yao
Ming
M
Huang
Shang-Yi
SY
Chen
Yee-Chun
YC
Chen
Yao-Chang
YC
Shen
Ming-Ching
MC
Wang
Chiu-Hwa
CH
Tsai
Woei
W
Chang
Shan-Chwen
SC
Tien
Hwei-Fang
HF
Luh
Kwen-Tay
KT
D000328:Adult; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005334:Fever / Q000382:microbiology*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D009503:Neutropenia / Q000150:complications*; D012189:Retrospective Studies; D013624:Taiwan