title: Febrile Neutropenia in Hematological Malignancies: Clinical and Microbiological Profile and Outcome in High Risk Patients.
abstract: OBJECTIVE
  Febrile neutropenia (FN) is considered a medical emergency. Patients with hematological malignancies (HM) commonly experience FN. Broad spectrum antibiotics have to be started empirically to prevent complications. This study depicts the clinical profile, microbiological profile, antibiotic sensitivity pattern, and outcome in high risk HM.
  
  
  METHODS
  In this prospective study, 72 patients with hematologic malignancies, diagnosed and treated for 108 high risk febrile neutropenic episodes from August 2011 to January 2013 at a Regional Cancer Center, in South India were analyzed. Cefoperazone-sulbactum was used as a first-line empiric antibiotic.
  
  
  RESULTS
  Majority of the patients with FN episodes had acute myeloid leukemia. Overall culture positivity was 29.62%. The most common organisms isolated were Gram-negative bacilli (63.64%), with Escherichia coli being the most frequent pathogen. All Gram-negative organisms were sensitive to imipenem, whereas sensitivity pattern to other antibiotics were as follows: 85.71%, 78.26%, 69.52%, 63.64%, 41.66% and 47.05% for pipercillin-tazoactum, meropenem, cefoperazone-sulbactum, amikacin, ceftazidime, ciprofloxacin respectively. Overall mortality was 13.5%. Most of the patients responded to empiric antibiotic cefoperazone-sulbactum.
  
  
  CONCLUSIONS
  In the hematologic malignancies particularly in acute leukemia, there is high risk of developing FN. Empiric therapy with cefoperazone-sulbactum as a first line leads to satisfactory outcome in high risk FN and therapy should be tailored to the most appropriate antibiotics according to the bacterial culture results.
authors.affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
authors.forename: Kuntegowdanahalli C
authors.initials: KC
authors.lastname: Lakshmaiah
authors.affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
authors.forename: Abhayakumar S
authors.initials: AS
authors.lastname: Malabagi
authors.affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
authors.lastname: Govindbabu
authors.affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
authors.forename: Rachan
authors.initials: R
authors.lastname: Shetty
authors.affiliation: Department of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
authors.forename: Mahua
authors.initials: M
authors.lastname: Sinha
authors.affiliation: Department of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
authors.forename: Rudrapatna S
authors.initials: RS
authors.lastname: Jayashree
keywords: Antibiotics; Gram-negative organism; febrile neutropenia; hematological malignancies; treatment