Emergence of MRSA in positive blood cultures from patients with febrile neutropenia--a cause for concern.
OBJECTIVE
Febrile neutropenia (FN) causes considerable morbidity in patients on cytotoxic chemotherapy. Recently, there has been a trend towards fewer Gram-negative and more Gram-positive infections with increasing antibiotic resistance. To assess these patterns, data from a supra-regional cancer centre in Ireland were reviewed.


METHODS
A 5-year review of all positive blood cultures in patients undergoing anti-cancer chemotherapy was carried out.


RESULTS
Eight hundred and ninety-four patients were reviewed. The mean incidence of FN was 64.2 cases per year. Eight hundred and forty-six blood culture specimens were taken and 173 (20.4%) were culture positive. The isolated organisms were Gram positive (71.1%), Gram negative (27.8%) and fungal (1.1%). Of the Gram-positive organisms, 75.6% were staphylococci. Of these, 67.8% were coagulase-negative staphylococci and 30.1% were Staphylococci aureus. Amongst the S. aureus, 89.3% were methicillin-resistant (MRSA). Vancomycin-resistant enterococci were not identified as a cause of positive blood cultures.


CONCLUSIONS
Amongst patients with cancer who develop FN in our hospital, Gram-positive bacteria account for the largest proportion. The high proportion of MRSA as a cause of positive blood cultures is of concern.
Morris
Patrick G
PG
Department of Oncology, Beaumont Hospital, Dublin 9, Dublin, Ireland.
Hassan
Tidi
T
McNamara
Mairead
M
Hassan
Astrid
A
Wiig
Rebecca
R
Grogan
Liam
L
Breathnach
Oscar S
OS
Smyth
Edmond
E
Humphreys
Hilary
H
D000970:Antineoplastic Agents / Q000009:adverse effects*; D002555:Cerebrospinal Fluid; D005334:Fever / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006403:Hematologic Tests; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D016106:Methicillin Resistance / Q000187:drug effects*; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000097:blood* / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology; D016522:Oncology Service, Hospital; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000097:blood* / Q000453:epidemiology; D020713:Vancomycin Resistance / Q000187:drug effects*
D000970:Antineoplastic Agents