Bacterial Epidemiology of Febrile Neutropenia in Patients With Hematological Cancers at an Academic Center in South East Asia

Febrile neutropenia (FN) is a common complication in patients with hematological cancers. The risk of infection is high and contributes significantly to morbidity and mortality. As data on FN are limited in Southeast Asia, this study aims to evaluate the epidemiological characteristics and outcomes of these patients. A retrospective cohort study was conducted on patients with hematological cancers who developed FN from January 2019 to December 2021. Patients’ demographics, disease type, microbiological findings, clinical outcomes, and 30-day mortality were analysed. A total of 246 FN episodes occurring in 160 patients were analysed, with FN episodes as the unit of analysis. Bacteremia was detected in 42.3% (104/246) of FN episodes and was significantly associated with neutropenia lasting more than 7 days (p = 0.012, OR: 2.28; 95% CI, 1.18–4.18). Gram-negative organisms were more prevalent (61.5%, 75/122) than gram-positive organisms (38.5%, 47/122), with Klebsiella pneumoniae (21.3%, 26/122) and Escherichia coli (20.4%, 25/122) the most common. Extended-spectrum beta-lactamase (ESBL) producers were found in 18.7% (14/75), while 68.1% (32/47) of gram-positive isolates were methicillin-resistant. The median duration of hospitalization was 20 days with a 30-day mortality rate per episode of 13.4% (33/246). In univariate analysis, higher mortality per episode was associated with older age (p = 0.037, OR: 2.23; 95%CI, 1.04–4.82, prolonged neutropenia (p = 0.022, OR:3.83; 95%CI, 1.13–6.03), presence of bacteremia (p = 0.008, OR:2.74; 95%CI, 1.28–5.87), and infections with resistant organisms (p = 0.002. OR:3.19; 95%CI, 1.47–6.89). FN remains a serious complication, with bacteremia and resistant infections contributing to increased mortality. Regular updates on microbiology profiles are critical for guiding appropriate antimicrobial therapy. Antimicrobial stewardship programs are essential to minimize the emergence of resistant organisms.