Microbiologic Spectrum and Antimicrobial Resistance in Febrile Neutropenia: Experience from an Eastern India Hematology Centre
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Background
Febrile neutropenia (FN), a life-threatening complication of chemotherapy, is a medical emergency requiring prompt antibiotic therapy. The epidemiology of causative pathogens is evolving with a shift towards multidrug-resistant (MDR) strains. This study aimed to evaluate the microbiologic spectrum and antimicrobial resistance patterns in FN patients at a hematology center in Eastern India.
Methods
A retrospective study was conducted on FN patients admitted between July 2022 and July 2024. Clinical and demographic data, along with microbiological isolates and their antimicrobial susceptibility, were analyzed. Samples were evaluated from blood, respiratory, urinary, skin and mucocutaneous sites. Antimicrobial susceptibility testing was performed using Vitek 2. Statistical analyses, including multinominal logistic regression, were performed to identify factors associated with MDR infections.
Results
Among the 1,604 FN episodes analyzed, the most common underlying hematologic malignancies were acute myeloid leukemia (46.2%) and acute lymphoblastic leukemia (34.3%). Blood culture positivity was 39%, with Gram-negative bacteria (GNB) (67.8%) predominating over Gram-positive bacteria (32.1%). The most frequently isolated GNB were Klebsiella oxytoca (12.4%), Klebsiella pneumoniae (8.5%), and Escherichia coli (7.3%). MDR isolates accounted for 30% of all pathogens, with significant resistance observed to fluoroquinolones (Ciprofloxacin: 57.8%) and carbapenems (Meropenem: 42.8%). MDR isolates of concern included carbapenem-resistant Acinetobacter baumannii (1.8%), carbapenem-resistant Enterobacterales (3.3%), and Candida auris (0.6%).
Conclusion
This study necessitates ongoing surveillance and antimicrobial stewardship among FN patients in view of emerging MDR strains. The current predominance of Enterobacterales suggests a need to re-evaluate empirical antibiotic choices.
Optimizing treatment strategies with newer β-lactam/β-lactamase inhibitors and targeted antimicrobial stewardship programs is essential in resource-limited settings.
