Epidemiology of Febrile Neutropenia Episodes with Gram-Negative Bacteria Infection in Patients Who Have Undergone Chemotherapy for Hematologic Malignancies: A Retrospective Study of 10 Years' Data from a Single Center

Figures & data

Table 1 Comparison of baseline characteristics and clinical data between patients with different initial empirical antibiotic treatments

	Non-IIAT (n=71)	IIAT (n=176)	P-value
Age, years (mean ± SD)	38.6±14.7	38.8±15.8	0.963
Sex (M/F)	51/20	99/77	0.023
Duration of fever (days), median (range)	3 (0–35)	4 (0–54)	0.179
Underlying disease			0.831
Acute lymphoblastic leukemia, n (%)	25 (35.2%)	61 (34.7%)
Acute myeloid leukemia, n (%)	31 (43.7%)	83 (47.1%)
Other hematologic malignancy^a, n (%)	15 (21.1%)	32 (18.2%)
Treatment type^b			0.592
Hematopoietic stem–cell transplantation, n (%)	27 (38.0%)	71 (40.3%)
High-dose chemotherapy, n (%)	33 (46.5%)	86 (48.9%)
Other chemotherapy, n (%)	11 (15.5%)	19 (10.8%)
Complications (grade 2–4)
Ventilator support, n (%)	6 (8.5%)	13 (7.4%)	0.795
Liver damage, n (%)	23 (32.4%)	78 (44.6%)	0.079
Respiratory failure, n (%)	8 (11.3%)	33 (18.9%)	0.148
Renal insufficiency, n (%)	47 (66.2%)	105 (60%)	0.365
Bleeding, n (%)	26 (36.6%)	67 (38.3%)	0.807
Diabetes, n (%)	3 (4.2%)	5 (2.9%)	0.693
Heart failure, n (%)	4 (5.6%)	18 (10.3%)	0.247
Death, n (%)	17 (23.9%)	66 (37.7%)	0.038

Notes: ^aOther hematologic diseases included multiple myeloma, myelodysplastic syndromes, non-Hodgkin’s lymphoma, and Hodgkin's lymphoma; ^btreatment regimens and classification summarized in Supplementary Table 1.

Table 2 Gram-negative bacteria pathogens and susceptibility to initial empirical treatment identified in febrile neutropenia patients

	Patients, n (%)	Death, n (%)	Sensitive to initial treatment, n (%)	Confirmed resistance to initial treatment (%)
E. coli	93 (40.0)	22 (43.0)	43 (46.2)	29 (31.2)
K. pneumoniae	49 (20.0)	21 (42.9)	19 (38.8)	11 (22.4)
P. aeruginosa	27 (11.0)	7 (25.9)	15 (55.6)	2 (7.4)
S. maltophilia	22 (9.0)	11 (50)	4 (18.2)	4 (18.2)
E. cloacae	8 (3.3)	2 (25)	1 (12.5)	4 (50)
S. paucimobilis	7 (2.9)	0	5 (71.4)	1 (14.3)
A. baumannii	5 (2.0)	5 (100)	1 (20)	NA
Pantoea	3 (1.2)	0	1 (33.3)	NA
Clostridium falciparum	2 (0.8)	1 (50)	0	1 (50)
Bacillus cereus	2 (0.8)	1 (50)	0	NA
Burkholderia cepacia	2 (0.8)	2 (100)	0	NA

Table 3 Bacteria prone to sensitivity/resistance to initial empirical antibiotic treatment

	Patients, n	Sensitive to initial treatment, n (%)		Patients, n	Confirmed resistance to initial treatment, n (%)
S. paucimobilis	7	5 (71.4)	E. cloacae	7	4 (57.1)
P. aeruginosa	27	15 (55.6)	E. coli	93	29 (31.2)
Pantoea	2	1 (50)	K. pneumoniae	49	11 (22.4)
E. coli	93	43 (46.2)	S. maltophilia	22	4 (18.2)
K. pneumoniae	49	19 (38.8)	S. paucimobilis	7	1 (14.3)
A. baumannii	5	1 (20)	P. aeruginosa	27	2 (7.4)
S. maltophilia	22	4 (18.2)

Table 4 Empirical treatment with monotherapy/combined antibiotics and probability of IIAT

	Patients (n)	IIAT (n)	IIAT
Monotherapy
β-lactamase inhibitors	1	1	100%
Fluoroquinolones	33	17	52%
Metronidazole	14	7	50%
Oxazolidinones	2	1	50%
Cephalosporin	63	22	35%
Anti-Pseudomonas penicillin	17	6	35%
Glycopeptide antibiotics	42	8	19%
Carbapenems	63	10	16%
Aminoglycosides	12	1	8%
Tetracyclines	3	0	0
Macrolides	1	0	0
Combined antibiotics
Fluoroquinolones–metronidazole	10	5	50%
Fluoroquinolones–cephalosporins	9	3	33%
Anti-Pseudomonas penicillin–glycopeptides	6	2	33%
Cephalosporins–carbapenems	11	2	18%
Aminoglycosides–cephalosporins	6	1	17%
Fluoroquinolones–glycopeptides	6	1	17%
Carbapenems–metronidazole	6	1	17%
Carbapenems–glycopeptides	21	3	14%
Cephalosporins–glycopeptides	15	2	13%
Fluoroquinolones–carbapenems	10	1	10%
Aminoglycosides–glycopeptides	5	0	0
Aminoglycosides–carbapenems	4	0	0
Others	18	5	28%

Table 5 Most commonly used antibiotics and confirmed resistance rate

	Patients (n)	Confirmed sensitivity (n)	Confirmed resistance (n)	Resistance rate
Monotherapy
Meropenem	12	12	0	0
Cefepime	8	4	4	50%
Moxifloxacin	6	1	5	83%
Ceftazidime	5	3	2	40%
Cefotaxime	4	1	3	75%
Combined antibotics
Imipenem–cilastin	10	6	4	40%
Piperacillin–tazobactam	8	5	3	38%
Moxifloxacin–metronidazole	5	1	4	80%
Meropenem–tecolanin	4	3	1	25%
Meropenem–vancomycin	4	2	2	50%
Cefoperazone–sulbactam	4	2	2	50%
Ceftazidime–vancomycin	4	2	2	50%
Imipenem–cilastatin–vancomycin	4	4	0	0
Piperacillin–tazobactam–vancomycin	3	1	1	33%