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Bacteraemia in neutropenic patients
B O'Connell1, P A Daly, S R McCann
1Department of Clinical Microbiology, St. James's Hospital, Dublin.
Irish Medical Journal
|November 1, 1993
Summary
Bacteraemia episodes are increasing in cancer patients with neutropenia, primarily caused by Gram-positive organisms. This trend highlights the need for updated antibiotic resistance data to guide effective empirical antimicrobial therapy.
Area of Science:
- Infectious Diseases
- Oncology
- Clinical Microbiology
Background:
- Empirical antibiotic therapy for febrile neutropenic patients requires knowledge of local microbial resistance patterns.
- Rising bacteraemia rates in neutropenic patients necessitate updated antimicrobial stewardship.
Purpose of the Study:
- To review blood culture isolates and antibiotic resistance patterns in neutropenic cancer patients.
- To guide empirical antimicrobial therapy based on local resistance data.
Main Methods:
- Retrospective evaluation of all positive blood culture isolates from a mixed hematology/oncology unit.
- Data collected over a four-year period (1988-1991).
Main Results:
- Bacteraemia episodes increased from 9% in 1988 to 13.7% in 1991.
- Gram-positive organisms were the predominant isolates (61.3%-72.7% annually).
- Vancomycin showed sensitivity against all Gram-positive isolates; piperacillin and tobramycin demonstrated reduced activity.
Conclusions:
- Increasing bacteraemia in neutropenic patients is linked to Gram-positive organisms.
- Extensive use of venous access devices may contribute to the rise in Gram-positive bacteraemia.
- Local antibiotic resistance data is crucial for optimizing empirical therapy in febrile neutropenic patients.