Factor isolation in febrile neutropenia in patients with hematological malignancies

Febrile neutropenia is a serious complication that causes high morbidity and mortality, and requires rapid recognition and treatment. When choosing empirical treatment, it is necessary to pay attention to the distribution of pathogens in the unit. In our study, 612 FN epizode in 412 patients were examined in order to evaluate the distribution of pathogens isolated from patients with febrile neutropenia (FN) hospitalized at Gaziantep University Hospital Adult Hematology Clinic between 2018 and 2022, their antibiotic susceptibility, changes over the years and their relationship with mortality. 41,5% of FN epizodes were evaluated as MDI (Microbiologically Defined Infection), 29,4% in FUO (Unexplained Fever), 29,1% in CDI (Clinically Defined Infection) category. It was determined that culture growth rates increased in the high-risk patient category, Leukemia group, and with increased depth of neutropenia (p<0,05). Gram-negative (GN) bacteria were the most common cause of bacteremia. The most frequently detected bacterial pathogens are respectively; K. pneumoniae, E. coli, CNS. Methicillin resistance was found 81,5% in Staphylococcus spp., vancomycin resistance 64% in Enterococcus spp., extended spectrum beta lactamase (ESBL) production in Klebsiella spp. 98%, and ESBL production in E.coli 69%. 8,9% of the patients were positive for CMV PCR, 1,1% for Candidamannan, 4,3% for Galactomannan (GMN), 4,9% for COVID PCR. 32,4% of the patients resulted in mortality due to febrile neutropenia. Mortality increased with advanced age, low neutrophil count, high CRP and PCT, GN bacteremia, pneumonia, and GMN positivity (p<0,05). Piperacillin-tazobactam, ceftazidime and cefepime should not be considered in the foreground due to high resistance in GN bacteria in terms of empirical treatment in our clinic. It is important to customize the treatments by regularly monitoring the distribution of infectious pathogens in the centers and taking local data into account.