Changes in Etiologic Microorganisms in Thai Patients with
Chemotherapy-Induced Neutropenia and Fever
Chonticha Auesomwang MD1, Bundarika Suwannawiboon MD2, Methee Chayakulkeeree MD, PhD3
Affiliation :
1 Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
3 Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Background : Infection in patients with chemotherapy-induced neutropenia is a serious complication that causes signi(cid:976)icant
morbidity and mortality. Prompt and appropriate antimicrobial therapy improves treatment outcomes. However, mortality rate
and complications in patients with febrile neutropenia were still high. Etiologic infectious agents of febrile neutropenia differ among
countries and they change periodically.
Objective : To identify the clinical characteristics and etiologic organisms in patients with febrile neutropenia at Siriraj Hospital,
and to identify factors that signi(cid:976)icantly predict patient outcomes
Materials and Methods : The medical records of patients with febrile neutropenia hospitalized at Siriraj Hospital between January
2008 and June 2010 were analyzed. Patient characteristics, epidemiologic data, bacteriologic data, and factors at the onset of fever
were collected to predict patient outcomes. The data from this study was compared with data from a similar study conducted at
our center in 2000.
Results : Of 234 patients with 310 febrile neutropenic episodes, 80.8% had hematologic malignancies and 19.2% had solid tumors.
Mean age of the 105 male and 129 female patients was 46.6±16.3 years. Patients recovered in 43.2% of cases, and the overall
mortality rate was 19.7%. Bacteremia was found in 23.9% of cases. Gram-negative bacteria were the most common causative
organisms. Compared with data from the study conducted in 2000, there was no signi(cid:976)icant change in the prevalence of Gram-negative
and Gram-positive bacteria. The prevalence of extended-spectrum beta-lactamase [ESBL]-producing gram-negative bacteria is
29.8%. A signi(cid:976)icant increase in the prevalence of fungemia in febrile neutropenic patients was observed between the 2000 and
2010 study (0% to 6.7%, p = 0.045). Multivariate analysis revealed malignancy type, body temperature, and blood pressure to be
factors that independently predict patient outcome.
Conclusion : Consistent with the 2000 study (cid:976)inding, Gram-negative bacteria are still the most common etiologic organisms in febrile
neutropenic patients at Siriraj Hospital. However, we found an increase in the proportion of ESBL-producing Gram-negative bacteria
and fungal pathogens. Peak temperature of 39°C or higher and hypotension were identi(cid:976)ied as signi(cid:976)icant predictors of unfavorable
outcomes, including death. Ongoing and vigilant surveillance of changing and emerging organisms is essential for optimizing patient
outcomes.
Keywords : Febrile neutropenia, Chemotherapy-induced neutropenia, Fever, Epidemiology, Neutropenic
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