Khawaja Farhan Zahid, Haroon Hafeez, Ammarah Afzal


Background: The aim of this study was to study trends in bacterial spectrum and susceptibility
patterns of pathogens in adult febrile neutropenic patients during two time periods. Methods: We
retrospectively reviewed the medical records of 379 adult oncology patients admitted with
chemotherapy induced febrile neutropenia at our institute during years 2003 and 2006. Results: A
total of 151 organisms were isolated during the two calendar years. Gram negative bacteria
accounted for 57.6% of organisms, while gram positive organisms accounted for 42.3% of the
total isolates. The most common organisms were: Escherichia coli (23.1%), Staphylococcus
epidermidis (13.9%), Pseudomonas aeruginosa (12.5%) and Staphylococcus aureus (7.9%). The
number of gram positive isolates showed an increase from 35% in 2003 to 47.2% in 2006
(p=0.13). During each calendar year, Staphylococcus epidermidis and Staphylococcus aureus were
100% susceptible to vancomycin and 33% strains of Staphylococcus aureus were methicillin
resistant. Escherichia coli and Pseudomonas aeruginosa strains were highly sensitive to
piperacillin/tazobactam and amikacin during both time periods. Resistance of Pseudomonas
aeruginosa strains to ciprofloxacin increased from 0% in 2003 to 50% in 2006 (p=0.03).
Conclusions: Gram negative organisms are the predominant organisms in adult febrile
neutropenic patients at our institute. Initial empirical therapy with piperacillin/tazobactam seems
appropriate to cover most gram negative pathogens while vancomycin to be added for suspected
gram positive infections. During the two calendar years resistance of Pseudomonas aeruginosa
strains to ciprofloxacin has significantly increased.
Keywords: Bacterial spectrum, Febrile neutropenic patients, Empirical therapy

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