Bacteremia in Swedish hematological patients with febrile neutropenia: Bacterial spectrum and antimicrobial resistance patterns

Abstract

Background: The etiology of bacteremia in hematological patients with febrile neutropenia differs geographically and changes over time. Since efficient empirical antibiotic treatment depends on relevant knowledge of the bacterial panorama, the aim of this study was to describe the prevalence of bacteremia, the bacterial spectrum, and the resistance patterns of the isolates in this group today. Methods: In a cross-sectional study, routine blood cultures from febrile episodes occurring in adult patients with hematological disorders and neutropenia presenting to Karolinska University Hospital, Stockholm, Sweden during a 24-month period, were analyzed. Results: A total of 142 febrile neutropenic episodes occurring in 124 hematological patients were included in the study. Bacteremia was documented in 27% of the episodes, and of these, 58% were due to Gram-positive pathogens. The most common isolates were viridans streptococci, coagulase-negative staphylococci, and Escherichia coli. Low levels of antibiotic resistance were detected. The underlying diagnosis of non-Hodgkin's lymphoma (NHL) was independently negatively associated with documented bacteremia (p < 0.01). Conclusions: The prevalence of bacteremia and the bacterial spectrum were consistent with recent Scandinavian reports. Substantially lower levels of antimicrobial resistance were registered compared to those found in other European centers. Patients with NHL were less likely to have documented bacteremia in this study.

Keywords::

• Febrile neutropenia
• bacteremia
• Gram-positive
• Gram-negative
• resistance

Acknowledgements

The authors would like to thank all the patients involved. We are indebted to the nurses, study nurses, and Dr Jan Sjöberg and Dr Per-Anders Broliden at the Hematology Center and the staff of the Accident and Emergency Department, Karolinska University Hospital, for their dedication to the study. We acknowledge the staff of the Department of Clinical Microbiology at Karolinska University Hospital.

Declaration of interest: The authors declare that they have no competing interests.