Document Type

Artefact

Department

Internal Medicine (East Africa)

Abstract

Background: Febrile neutropenia is a major cause of mortality and morbidity among patients with cancer who receive chemotherapy. Current management guidelines for febrile neutropenia include the timely initiation of empiric antibiotic therapy. The choice of empiric antibiotic therapy is ideally based on factors such as local epidemiological bacterial aetiology and antibiotic resistance patterns as well as patient factors. There is a growing worldwide trend of isolation of multi-drug-resistant gram-negative bacteria in patients suffering from febrile neutropenia. A major challenge in sub-Saharan Africa is the lack of data on adult patients with febrile neutropenia, including mortality rates and length of hospital stay. There is also very limited data within sub-Saharan Africa on the local epidemiological microbiological aetiology and antibiotic resistance patterns of organisms isolated in febrile neutropenia to guide the choice of an empiric antibiotic regimen. Objective: What is the case fatality rate of adult patients with febrile neutropenia after chemotherapy who are admitted at the Aga Khan University Hospital? Methods: This was a retrospective descriptive study of adult patients hospitalized with chemotherapy-induced febrile neutropenia between 1st January 2017 and 31st July 2022. Data were extracted from the medical records of eligible patients using an abstraction tool. Data were analysed using SPSS. Categorical data were presented as percentages and frequencies while continuous data were presented as median and interquartile ranges. Results: The study involved 90 episodes of febrile neutropenia involving 50 unique patients. The median age was 42.8 years (IQR: 31.3 to 65.0). Sixty-seven percent of the cases were male patients. The case fatality rate was 14.4% (13) and the mortality rate was 26.0% of which 84.6% (9) had a haematological malignancy with Non-Hodgkin’s Lymphoma (NHL) being the most common at 46.2% (6). The median length of stay was 9 days (IQR 5.0, 17.0). Out of all the cases of febrile neutropenia, 27.8% of them had blood cultures that tested positive. Of these cases of bacteraemia, 68.0% (17) were gram-negative organisms. Klebsiella pneumonia was the most commonly isolated bacteria. Among the gram-negative bacteria isolated in blood, 23.5% (4) were third-generation cephalosporin-resistant and 11.7% (2) were carbapenem-resistant. iv Conclusion: The study found a higher mortality rate than in North American and Asian countries among patients with febrile neutropenia post-chemotherapy. Multi-drug resistant gram-negative bacteria were frequently isolated in blood, in keeping with global trends. There was a lower incidence of gram-positive bacteraemia locally as compared to North American countries.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Download

Share

COinS