Febrile Neutropenia in Acute Leukemic Patients Receiving Chemotherapy at Faculty of Medicine Vajira Hospital, Navamindradhiraj University

Abstract

Objectives: The study aimed to assess the type of pathogens, sites of infection and overall mortality rate including the factors that influenced the mortality in acute leukemia patients who had febrile neutropenia episodes after receiving chemotherapy in Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University from 2009 to 2012.

Methods: All in-patients medical record of acute leukemic patients receiving chemotherapy diagnosed with febrile neutropenia at Faculty of Medicine Vajira Hospital, Navamindradhiraj University from January 1, 2009 to December 31, 2012 were reviewed and analyzed.

Results: From January 1, 2009 to December 31, 2012, there were 37 patients (83 episodes) diagnosed with febrile neutropenia after chemotherapy treatment. Approximately half (51.4%) were male. The majority of patients were acute myeloid leukemia and the regimen that associated febrile neutropenia was cytarabine and idarubicin regimen. This study found the common sites of infection were pneumonia (26%) and septicemia (24.4%) respectively. The common organism was gram-negative bacteria (75.9%) and also found drug-resistant gram-negative bacteria (11.7%) such as E.coli (ESBL), P.aeruginosa (MDR) and A.baumanii (CRAB). The mortality rate was 27.7% and the factor that affected the mortality was absolute neutrophil count below 100 cells/μL (p-value = 0.049).

Conclusion: Gram-negative bacteria was the most common pathogen. There was higher incidence of drug-resistant bacteria compared with previous studies. Our findings suggest that the physician should be aware of drug-resistant gram-negative bacteria and promptly starts the appropriate antibiotic to reduce the mortality in these patients.