Bacteremia in patients with febrile neutropenia after chemotherapy at a university medical center in Malaysia.
OBJECTIVE
This study was initiated to determine the local profile of blood culture isolates and antibiotic sensitivities in febrile neutropenic patients following chemotherapy, and to establish if any modifications to treatment guidelines are necessary.


METHODS
A total of 116 episodes of febrile neutropenia admitted to the adult hematology ward at a university medical center in Malaysia were studied retrospectively from January 2004 to January 2005.


RESULTS
The study showed 43.1% of febrile neutropenic episodes had established bacteremia. Gram-negative bacteria accounted for 60.3% of isolates. Sensitivities of Gram-negative bacteria to the antibiotics recommended in the Infectious Diseases Society of America (IDSA) guidelines were 86.1-97.2%. Coagulase-negative staphylococci were the most common Gram-positive organisms isolated (23.3%). The majority of these were methicillin-resistant.


CONCLUSIONS
Carbapenem monotherapy, as recommended in the 2002 IDSA guidelines, is effective treatment for the infections most often encountered at our center. Combination therapy with an aminoglycoside should be considered when using ceftazidime, cefepime or piperacillin-tazobactam, particularly in high-risk patients. Vancomycin should be used if a Gram-positive organism is suspected or isolated.
Baskaran
Nirmala Devi
ND
Department of Medicine, Kajang Hospital, Kajang, Selangor, Malaysia.
Gan
Gin Gin
GG
Adeeba
Kamarulzaman
K
Sam
I-Ching
IC
D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016470:Bacteremia / Q000382:microbiology*; D001419:Bacteria / Q000187:drug effects; D024901:Drug Resistance, Multiple, Bacterial; D005334:Fever / Q000209:etiology*; D006801:Humans; D008296:Malaysia; D009503:Neutropenia / Q000139:chemically induced*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents