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Analysis of blood stream infections, antibiograms and clinical outcomes in haematological patients with febrile neutropenia: data from a tertiary care haematology institute in India

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Abstract

Timely administration of appropriate empirical antibiotics in febrile neutropenia is crucial for favourable patient outcomes. There are guidelines in place recommending such antibiotics. However, regional variations and local epidemiological data must be evaluated to tailor the antibiotics for best possible and rational use. In this study, we audited the clinical and microbiological data of febrile neutropenic episodes occurring at a tertiary care haematology institution. Three hundred and ninety-three febrile neutropenic episodes occurring in 123 patients over a 1-year period were analysed for microbial profile, sensitivity and resistance patterns, and finally clinical outcomes. Gram-negative bacilli (GNB) blood stream infections (46.9%) were more prevalent as compared to gram-positive infections (41.9%). Overall mortality due to complicated neutropenic sepsis was 19.5% (24/123 patients). Increased resistance to carbapenems, beta-lactam beta-lactamase inhibitor combinations, aminoglycosides, fluoroquinolones, and cephalosporins were observed. Cefepime and tigecycline resistance were seen in 20% and 15% GNB isolates, respectively. Chest was the most frequent focus of infection, and acute myeloid leukaemia (AML) was the most common underlying disorder which correlated with the likelihood of death (p < 0.01). Multidrug-resistant GNB (esp. Klebsiella sp.) are still most worrisome isolates in neutropenic patients. Single-agent cefepime or piperacillin-tazobactam/tigecycline combination may be considered empirical agents. Chest infections and AML were independent predictors of poor clinical outcome in neutropenic patients. Regular audit of infections and antibiotic susceptibility data is needed to improve clinical outcomes in patients with febrile neutropenia.

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Authors and Affiliations

  1. Institute of Haematology and Transfusion Medicine, Medical College Hospital, 88, College Street, Kolkata, West Bengal, 700073, India

    Shouriyo Ghosh, Sambit Samanta, Nilanjan Sinha, Sandeep Saha, Arnab Chattopadhyay, Siddhartha Sankar Roy & Maitreyee Bhattacharyya

  2. Department of Microbiology, Medical College Hospital, Kolkata, India

    Mandira Chakraborty

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  1. Shouriyo Ghosh
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Contributions

Shouriyo Ghosh: concept, clinical data curation, statistics, manuscript drafting, editing, and analysis

Mandira Chakraborty: microbiological data collection, archiving, analysis

Sambit Samanta: clinical management, decision-making, concept

Nilanjan Sinha: clinical management, decision-making

Sandeep Saha: clinical management, decision-making

Arnab Chattopadhyay: clinical management, decision-making

Siddhartha Sankar Roy: clinical management, decision-making

Maitreyee Bhattacharyya: concept, manuscript editing, analysis, overall supervision

Corresponding author

Correspondence to Maitreyee Bhattacharyya.

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The authors declare that they have no conflict of interest.

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The study was approved by the Institutional Ethical Committee, Medical College Hospital, Kolkata.

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Informed consent was taken from patients.

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Yes

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Mandira Chakraborty is a co-first author

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Ghosh, S., Chakraborty, M., Samanta, S. et al. Analysis of blood stream infections, antibiograms and clinical outcomes in haematological patients with febrile neutropenia: data from a tertiary care haematology institute in India. Ann Hematol 100, 395–403 (2021). https://doi.org/10.1007/s00277-020-04324-8

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  • DOI: https://doi.org/10.1007/s00277-020-04324-8

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