• Khawaja Farhan Zahid
  • Haroon Hafeez
  • Ammarah Afzal


Background: The aim of this study was to study trends in bacterial spectrum and susceptibilitypatterns of pathogens in adult febrile neutropenic patients during two time periods. Methods: Weretrospectively reviewed the medical records of 379 adult oncology patients admitted withchemotherapy induced febrile neutropenia at our institute during years 2003 and 2006. Results: Atotal of 151 organisms were isolated during the two calendar years. Gram negative bacteriaaccounted for 57.6% of organisms, while gram positive organisms accounted for 42.3% of thetotal isolates. The most common organisms were: Escherichia coli (23.1%), Staphylococcusepidermidis (13.9%), Pseudomonas aeruginosa (12.5%) and Staphylococcus aureus (7.9%). Thenumber 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 were100% susceptible to vancomycin and 33% strains of Staphylococcus aureus were methicillinresistant. Escherichia coli and Pseudomonas aeruginosa strains were highly sensitive topiperacillin/tazobactam and amikacin during both time periods. Resistance of Pseudomonasaeruginosa 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 febrileneutropenic patients at our institute. Initial empirical therapy with piperacillin/tazobactam seemsappropriate to cover most gram negative pathogens while vancomycin to be added for suspectedgram positive infections. During the two calendar years resistance of Pseudomonas aeruginosastrains to ciprofloxacin has significantly increased.Keywords: Bacterial spectrum, Febrile neutropenic patients, Empirical therapy


Butt T, Afzal RK, Ahmed RN, Salman M, Mahmood A, Anwar

M. Bloodstream infections in febrile neutropenic patients:

bacterial spectrum and antimicrobial susceptibility pattern. J

Ayub Med Coll Abbotabad 2004;16(1):18–22.

Burney IA, Farooqui BJ, Siddiqui T, Khurshid M. The spectrum

of bacterial infections in febrile neutropenic patients: effect on

empiric antibiotic therapy. J Pak Med Assoc 1998;48:364–7.

Khan MA, Siddiqui BK, Shamim A, Yousaf MA, Ahmad U,

Zakiullah N, et al. Emerging bacterial resistance patterns in

febrile neutropenic patients: experience at a tertiary care hospital

in Pakistan. J Pak Med Assoc 2004;54:357–60.

Irfan S, Idress F, Mehraj V, Habib F, Adil S, Hasan R.

Emergence of carbapenem resistant gram negative and

vancomycin resistant gram positive organisms in bacteremic

isolates of febrile neutropenic patients: a descriptive study. BMC

Infectious Diseases 2008;8:80.

Cattaneo C, Quaresmini G, Casari S, Capucci MA, Micheletti M,

Borlenghi E, et al. Recent changes in bacterial epidemiology and

the emergence of fluoroquinolone-resistant Escherichia coli

among patients with hematological malignancies: results of a

prospective study on 823 patients at a single institution. J

Antimicrob Chemother 2008;61:721–8.

Sigurdardottir K, Digranes A, Harthug S, Nesthus I, Tangen J,

Dybdahl B et al. A multi-centre prospective study of febrile

neutropenia in Norway: Microbiological findings and

antimicrobial susceptibility. Scand J Infect Dis 2005;37:455–64.

Blahova J, Kralikova K, Krcmery SR, Babalova M, Menkyna R,

Glosova L, et al. Monitoring of antibiotic resistance in bacterial

isolates from bacteremic patients. J Chemother 2004; 16:269–272.

Ramphal R. Changes in the etiology of bacteremia in febrile

neutropenic patients and the susceptibilities of the currently

isolated pathogens. Clin infect Dis 2004;39:S25–31.

Viscoli C, Varnier O, Machetti M. Infections in patients with

febrile neutropenia: epidemiology, microbiology and risk

stratification. Clin Infect Dis 2005;40:S240–5.

Baskaran ND, Gan GG, Adeeba K, Sam IC. Bacteremia in

patients with febrile neutropenia after chemotherapy at a

university medical center in Malaysia. Int J Infect Dis


Mortlock S. Bacteraemia among patients attending a cancer

hospital in Lahore, Pakistan. Br J Biomed Sci 2000;57:119–25.

Kirby JT, Fritsche TR, Jones RN. Influence of patient age on the

frequency of occurrence and antimicrobial resistance patterns of

isolates from hematology/oncology patients: report from the

chemotherapy alliance of neutropenics and the control of

emerging resistance program. Diagn Microbiol Infect Dis


Wareham DW, Bean DC, Khanna P, Hennessy EM, Krahe D,

Ely A, et al. Bloodstream infection due to Acinetobacter spp:

epidemiology, risk factors and impact of multi-drug resistance.

Eur J Clin Microbiol Infect Dis 2008;27:607–12.

Bow EJ, Rotstein C, Noskin GA, Laverdiere M, Schwarer AP,

Segal BH. A randomized, open label, multicenter comparative

study of the efficacy and safety of piperacillin-tazobatam and

cefipime for the empirical treatment of febrile neutropenic

episodes in patients with hematological malignancies. Clin Infect

Dis 2006;43:447–59.

Segal BH, Baden LR, Brown AE, Casper C, Dubberke E,

Freifeld AG, et al. Prevention and treatment of cancer related

infections. NCCN Practice Guidelines in Oncology 2008.p1–103.