title: Bloodstream infections in febrile neutropenic patients at a tertiary care center in Lebanon: a view of the past decade.
abstract: OBJECTIVE
  Previous studies from Lebanon have shown Gram-negative organisms to be the predominant agents in febrile neutropenic patients. The objective of this study was to evaluate the most current epidemiological trends among patients with neutropenic fever.
  
  
  METHODS
  This prospective observational cohort study, the largest to date in the country, was conducted at the American University of Beirut Medical Center between January 2001 and December 2003, with the objective of describing the characteristics of patients with neutropenic fever and to assess temporal trends.
  
  
  RESULTS
  We included 177 episodes of neutropenic fever. The most common underlying malignancy was lymphoma (42.4%). Gastrointestinal and abdominal infections were predominant (31.6%) and 23.7% of cases represented fever of unknown origin. Gram-negative organisms were responsible for 78.8% (26/33) of bloodstream infections compared to 33.3% (11/33) with Gram-positive organisms. The in-hospital mortality rate in this study (12.1%) was considerably lower than in previous years.
  
  
  CONCLUSIONS
  Gram-negative organisms are persistently predominant in our center. In a developing country like Lebanon with limited resources, lower mortality rates commensurate with worldwide reports were successfully achieved in this high-risk patient population. Protocols and guidelines should be adapted to the characteristics of individual institutions to ensure delivery of appropriate care to febrile neutropenic patients.
authors.affiliation: Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA, and Hammoud Hospital, Sidon, Lebanon.
authors.forename: Zeina A
authors.initials: ZA
authors.lastname: Kanafani
authors.forename: Ghenwa K
authors.initials: GK
authors.lastname: Dakdouki
authors.forename: Khalil I
authors.initials: KI
authors.lastname: El-Chammas
authors.forename: Shaker
authors.initials: S
authors.lastname: Eid
authors.forename: George F
authors.initials: GF
authors.lastname: Araj
authors.forename: Souha S
authors.initials: SS
authors.lastname: Kanj
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000382:microbiology; D009503:Neutropenia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies