Brief report
Risk factors for multidrug-resistant bacteremia in hospitalized cancer patients with febrile neutropenia: A cohort study

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We conducted a prospective cohort study in a single tertiary hospital with the aim of assessing predictors of multidrug-resistant bacteremia in 307 cases of febrile neutropenia in adult patients with cancer. On multivariate analysis using stepwise logistic regression, age (P = .009), duration of neutropenia (P = .022), and presence of an indwelling central venous catheter (P = .022) were associated with bloodstream infection by multidrug-resistant bacteria.

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Methods

A prospective cohort study was conducted in the hematology ward of Hospital de Clínicas de Porto Alegre, which is a tertiary referral center for bone marrow transplantation in southern Brazil. We screened all consecutive subjects admitted between October 2009 and August 2011. Patients age ≥18 years with neutropenia secondary to cytotoxic chemotherapy (absolute neutrophil count [ANC] <500 cells/mm³ or <1,000 cells/mm3 with an expectation of decreasing to <500 cells/mm³ over the subsequent 48

Results

A total of 307 episodes of FN were evaluated. Antibiotic prophylaxis with fluoroquinolones was not administered to any patient. During the study period, 115 BSIs were documented. The predominant pathogens were Escherichia coli (38.2%), coagulase-negative Staphylococcus spp (31.3%), Klebsiella pneumoniae (11.3%), Pseudomonas aeruginosa (9.5%), and Streptococcus spp (6.0%).

Among all BSIs evaluated, 38 episodes (33.0%) were caused by MDR bacteria; of these, 68.4% were caused by gram-positive

Discussion

This study shows that older patients with prolonged neutropenia and patients with an indwelling central venous catheter were more likely to develop a BSI caused by MDR bacteria. In particular, age and the presence of an indwelling central venous catheter were associated with gram-positive MDR bacteremia, whereas prolonged neutropenia was associated with gram-negative MDR bacteremia.

Although our results seemingly differ from those of previous studies, the published studies of risk factors for

Acknowledgment

We thank all of the patients and the data collection team who created the database.

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Cited by (0)

Conflicts of interest: None to report.

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