ABSTRACT:
Objectives: To assess the incidence of bacteraemia in febrile neutropenic (FN) patients and to assess the pattern of bacteraemia in FN cancer patients. To assess the prescription pattern of empirical antibiotic therapy in FN cancer patients, specific antibiotic therapy in FN cancer patients with bacteraemia and to assess the sensitivity and resistance pattern of antibiotics in cancer patients with FN and bacteraemia. To correlate between the febrile neutropenia and the risk factors. Methodology: A prospective Observational study was conducted in Sri Shankara Cancer Hospital and Research center, Bengaluru-04, India. Study was conducted for 6 months in In-patients who were diagnosed to have FN. The incidence and pattern of bacteraemia in the FN cancer patients were assessed. The prescription patterns of empirical and specific antibiotics therapy were assessed. The susceptibility pattern of antibiotics to isolated pathogens in FN cancer patients was studied by using descriptive analysis and relation of FN development with other factors was analysed by logistic regression. Results: A total of 70 patients were observed in which 51% were males and 48% were females and the mean age of the study population was 50.54yrs. Out of 70 patients, 8 patients had positive blood cultures and out of which, Gram-positive Micro-organisms were found in 4(5.71%) and Gram-negative Micro-organisms in 2(2.85%)and polymicrobial cultures in 2(1.14%) patients. Out of 91 antibiotic prescriptions screened, it was found that 89.01% of antibiotics were prescribed as empirical therapy and 10.98% antibiotics were prescribed for specific therapy (Micro-organism culture positive patients) in FN patients. Meropenem 45.71% and Cefoperazone 44.28% were prescribed most commonly in this study group as empirical therapy. Cefoperazone 4.28% was found to be utilized more frequently than other antibiotics for culture proven cases. There was no correlation found between febrile neutropenia and other risk factors such as age, gender, eGFR, catheter usage, use of immuno-suppressants, anthracycline use in this study population. Conclusion: FN is the complication of cytotoxic chemotherapy. Prompt administration of empiric broad-spectrum antibiotic is life saving. Bacteraemia in neutropenic patients following chemotherapy for cancer is associated with high mortality, unless appropriate empiric antibiotic therapy is rapidly administered. Although many antibiotic regimens have been evaluated as monotherapy or in combination for FN, superiority of many particular regimen has not been established. Antibiotics prescription depends greatly on the prevalence of pathogens causing infection and their antibiotic susceptibility, which may change overtime.