Microbiological findings in febrile neutropenia

Background. This study was carried out to assess the isolation rate of bact erial and fungal causative agents in Mexican neutropenic adults with hemato logical neoplasia. Methods. A prospective observational survey involving 120 consecutive episo des of febrile neutropenia during 1 year was carried out. These episodes we re observed in 630 patients discharged with diagnoses of leukemia or lympho ma, or after bone-marrow transplantation. Results. At least one pathogen was isolated in 42 of 120 episodes (35%), an d was present in 39 patients with acute myeloid leukemia (AML) (43%), acute lymphoblastic leukemia (ALL) (23%), and in patients who underwent bane-mar row transplantation (20%). Primary bacteremia was the most frequent cause o f fever (24 episodes, 57%), followed by intravascular device-related infect ions (5 episodes, 17%), and soft-tissue infections (5 episodes, 15%). Esche richia coli (33%) was the most frequently isolated agent of primary bactere mia, followed by coagulase-negative Staphylococcus (29%.), and Klebsiella o xytoca (16%). Fungal infection was responsible for five events (4%): two ep isodes of pneumonia (Penicillium marneffei and Aspergillus fumigatus, one e vent each); two cases of fungemia, one due to Candida tropicalis and one to Rhodotorula gluttinis, and one cryptococcal meningitis event. Conclusions. The isolation rate, approximately 30%, was in accordance with previous reports; similar percentages of Gram-positive and Gram-negative is olates were found. A remarkably low rate of viridans group streptococci and fungal agents was observed, despite the fact that neutropenia is the main risk factor for infection due to these agents. Studies reporting local micr obiological findings are necessary because they support an antibiotic choic e for prophylaxis or therapy more accurately than reports from other areas. (C) 2000 IMSS. Published by Elsevier Science Inc.