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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

Authors Zhang Y, Zheng Y, Dong F, Ma H, Zhu L, Shi D, Li X, Li J, Hu J

Received 5 December 2019

Accepted for publication 7 February 2020

Published 26 March 2020 Volume 2020:13 Pages 903—910


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Joachim Wink

Yunxiang Zhang,1,2,* Yu Zheng,1,2,* Fangyi Dong,1,2,* Handong Ma,3 Liping Zhu,1 Dake Shi,4 Xiaoyang Li,1,2 Junmin Li,1,2 Jiong Hu1,2

1Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3John Hopcroft Center for Computer Science, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 4Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Junmin Li; Jiong Hu Tel +86 21 6437  0045 665  258
Fax +86-21-64374756

Background: The epidemiology of Gram-negative bacteria in patients with febrile neutropenia (FN) and their susceptibility to initial empirical antibiotic therapy is key to successful treatment during the treatment of hematologic malignancies.
Methods: A retrospective study was conducted. Patients with FN and confirmed laboratory results of Gram-negative bacteria infections were included. If no direct sensitivity of the identified pathogen to the initially prescribed antibiotic regimen was confirmed, it was defined as inappropriate initial antibiotic treatment (IIAT).
Results: A total of  247 patients with FN were proven to be infected with Gram-negative bacteria, and  200 were diagnosed with acute leukemia. The most commonly detected bacteria were Escherichia coli (40%), Klebsiella pneumoniae (20%), and Pseudomonas aeruginosa (11%). In sum,  176 patients were classified as IIAT. The mortality rate in the IIAT group was significantly higher (37.7% vs 23.9%, P=0.038). With monotherapy as empirical treatment, high possibility of IIAT with fluoroquinolones (52%) and cephalosporins (35%) was detected, while more sensitivity to carbapenems (16%) and glycopeptides antibiotics (19%) was noticed. With combined treatment, cephalosporins/carbapenems had with the lowest percentage of IIAT (18%).
Conclusion: In conclusion, inappropriate initial empirical antibiotic treatments were associated with higher mortality in patients with hematologic malignancies. The current empirical antibiotic regimen needs to be further optimized.

Keywords: febrile neutropenia, Gram-negative bacteria, hematologic malignancy, empirical antibiotic treatment, inappropriate initial antibiotic treatment

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