Bloodstream Infection in Febrile Neutropenic Patients in Bhumibol Adulyadej Hospital, Royal Thai Air Force
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Abstract
Background : Febrile neutropenia (FN) is a common complication in patients with hematologic malignancy. Because of severity and high mortality, data about the epidemiology of causative pathogens in FN patients is essential to guide the appropriate empirical antibiotic therapy and may improve outcomes.
Objectives : The primary objective was epidemiologic study in type, frequency, and prevalence ratio (PR) of causative pathogens of bloodstream infection in FN patients in Bhumibol Adulyadej Hospital. The secondary objective was antimicrobial susceptibility pattern of the pathogens.
Methods : A retrospective chart review of patients aged 18 years old or older with a diagnosis of FN who were hospitalized at Bhumibol Adulyadej Hospital from 1 December 2011 to 31 December 2019. Data on patient’s characteristics, time to obtain hemoculture, hemoculture results and antimicrobial susceptibility were collected and analyzed using descriptive and analytical statistics.
Results : A total of 755 episodes in 514 patients were identified but only 256 (33.9 %) episodes in 137 (26.7 %) patients had positive hemoculture. The mean age was 50.50 years-old and 70 % were female. Hematologic malignancy was the most common underlying disease (75.2 %). The average length of hospitalstay was 13.8+7.4 days (4-58 days). The main causative pathogens were gram-negative organisms (78.42 %) include Escherichia coli (25.39 %), Klebsiella pneumonia (19.92 %). Acinetobacter baumannii (10.10 %) and Pseudomonas aeruginosa
(9.76 %). Gram-positive organism and fungi were found in 14.48 % and 6.25 % respectively. The drug resistant pathogens tended to increase from 2011 to 2019. Hemoculture in patients admitted over 7 days were found drug resistant to Acinetobacter Baumannii and Enterobacteriaceae more than patients admitted within 7 days with statistical significance and the PR were 7.16 (95 % confidence interval (CI), 1.70-30.08; p=0.001) and 2.40 (95 %CI, 1.28-4.50; p=0.005) respectively. Susceptibility of the organisms from the hemocultures that obtained within 7 days of admissionwere frequently susceptible to 3rd-4th generation cephalosporin, piperacillin/tazobactam and carbapenems, but the susceptibility results of hemoculture more than 7 days showed frequently resistant.
Conclusions : Gram negative bacteria still was the common causative pathogens of bloodstream infection in febrile neutropenic patients. The drug resistance organisms tended to increase from the past and multidrug resistant organisms were frequently found in hemocultere that were obtained after 7 days of hemoculture more than 7 days showed frequently resistant.
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