High-risk febrile neutropenia in Auckland 2003-2004: the influence of the microbiology laboratory on patient treatment and the use of pathogen-specific therapy.
BACKGROUND
International guidelines recommend routine microbiological assessment of patients with febrile neutropenia, but do not recommend a change from broad-spectrum antibiotic therapy to pathogen-specific therapy when a clinically relevant organism has been isolated. The aim of the study was to determine the aetiology of febrile neutropenia in adult haematology patients at Auckland City Hospital, to document the changes in treatment made following isolation of a clinically relevant organism and to assess adverse outcomes in any patient who received pathogen-specific therapy after a positive culture result.


METHODS
The results of all microbiological tests together with antibiotic therapy were recorded from consecutive patients with fever and a neutrophil count <0.5 x 10(9)/L over 1 year beginning in May 2003.


RESULTS
One thousand one hundred and ninety-six specimens were collected from 81 patients during 116 episodes of febrile neutropenia. A pathogen was isolated from blood cultures in 40 episodes: Gram-positive cocci accounted for 46% of isolates and Gram-negative bacilli for 35%. Isolation of a pathogen from blood cultures resulted in a change of treatment in 25 of 40 (62.5%, 95%CI 46-77%) episodes. In 12 of these episodes, antibiotic therapy was optimized to a single pathogen-specific agent. No adverse events or subsequent changes in antibiotic therapy occurred in any of these 12 patients. Isolation of a pathogen from specimens other than blood seldom led to a change in therapy.


CONCLUSIONS
Isolation of a pathogen from blood cultures often allows antibiotic therapy to be simplified to a pathogen-specific regimen. Further study of this approach is warranted.
Ritchie
S
S
Infectious Diseases Department, Auckland City Hospital, Gafton, Auckland, New Zealand. sritchie@adhb.govt.nz
Palmer
S
S
Ellis-Pegler
R
R
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002404:Catheterization / Q000009:adverse effects; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D004351:Drug Resistance; D004866:Equipment Contamination; D005334:Fever / Q000209:etiology*; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000150:complications; D019337:Hematologic Neoplasms / Q000150:complications; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D008485:Medical Audit; D008826:Microbial Sensitivity Tests; D009503:Neutropenia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D013045:Species Specificity
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D005839:Gentamicins; D000077723:Cefepime