Appropriate Antimicrobial Therapy Reduced Mortality in Hematological Cancer Patients with Febrile Neutropenia in The Era of Multidrug Resistance
Wasithep Limvorapitak MD*, Thana Khawcharoenporn MD, MSc**
Affiliation : * Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Objective : To determine the effect of appropriate antimicrobial therapy (AAT) on mortality among Thai hematological cancer
patients with febrile neutropenia (FN).
Material and Method: A 6-year retrospective cohort study of hematological cancer patients receiving chemotherapy from
January 2008 to December 2013. Risk factors associated with mortality and the effect of AAT on mortality were determined.
Results : Of 893 chemotherapy episodes from 145 patients, FN occurred in 133 episodes (14.9%) from 67 patients. Of these
133 episodes, 61.6% were female and mean age was 47.9 years. Infections with multidrug-resistant organisms (MDROs)
occurred in 18.8% and extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae were the most common
MDROs. Among the 133 episodes, 100 (75.2%) were given AAT. Overall mortality rate was 20.3%. No receipt of AAT
[adjusted odds ratio (aOR) 9.54; p = 0.041], Multinational Association for Supportive Care in Cancer score of less than
21 points (aOR 4.37; p = 0.021), and systemic inflammatory response syndrome score of 4 (aOR 13.02; p = 0.037) were
independent factors associated with mortality.
Conclusion : AAT was associated with reduced mortality in hematological cancer patients with febrile neutropenia. Empirical
antimicrobials for FN should be active against ESBL-producing bacteria in this setting where these MDROs are endemic.
Keywords : Febrile neutropenia, Hematologic cancer, Mortality, Appropriate antimicrobials, Multidrug resistance
