Descriptive analysis of frequency and antimicrobial susceptibility of pathogens isolated from acute leukemia patients with febrile neutropenia over a five-year period at a tertiary hospital

Background Febrile neutropenia (FN) is a medical emergency in patients with acute leukemia due to profound neutropenia and immunosuppression, leading to life-threatening infections. Emerging antimicrobial resistance (AMR) further complicates management. Methods A retrospective descriptive study was conducted at a tertiary care hospital from January 2020 to December 2024. All pediatric and adult AL patients presenting with FN were included. Clinical records using ICD codes and laboratory data were analyzed to identify pathogen frequency, specimen source, and antimicrobial susceptibility patterns. Results A total of 478 FN episodes were identified through medical records, of which 217 (45%) were microbiologically documented. Among 381 isolated pathogens, Gram-negative rods (GNR) (n = 154, 40.4%) marginally exceeded Gram-positive cocci (GPC) (n = 148, 39%), followed by fungi (n = 41, 11%), viral (n = 24, 6%), parasitic (n = 8, 2%), and mycobacterial pathogens (n = 6, 1.6%). Blood was the most common culture source (n = 246, 71%). Predominant organisms included: Coagulase-negative staphylococci (CoNS) (n = 82, 24%), Enterococcus species (n = 23, 6.7%), and Staphylococcus aureus (n = 19, 5.5%) among GPCs; E. coli (n = 57, 16.6%), Pseudomonas aeruginosa (n = 22, 6.4%), and Klebsiella species (n = 20, 6%) among GNRs. Among GPCs, 77 CoNS isolates (95%) were methicillin-resistant, and 16 Enterococcus isolates (76%) were vancomycin-resistant. Among GNRs, Enterobacteriaceae showed resistance to ceftriaxone (n = 68, 77%), piperacillin-tazobactam (n = 51, 63%), and carbapenems (n = 34, 47%). Among fungi, Candida auris showed universal resistance to fluconazole, while echinocandins remained active against all Candida species. Conclusion Among culturable pathogens, CoNS were predominant. A high burden of multidrug-resistant organisms was identified, particularly vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae. Current empiric therapy (meropenem ± vancomycin) may no longer provide optimal coverage. Regular AMR surveillance and adjustment of empiric regimens are essential for improving outcomes.