Retrospective review of febrile neutropenia in the Royal Darwin Hospital, 1994-99

Background: Febrile neutropenia is a life-threatening complication of cytot oxic chemotherapy. Empirical antibiotic treatment should be based on predom inant pathogens and epidemiological characteristics of the treated communit y. The aim of the present study was to review cases of febrile neutropenia at the Royal Darwin Hospital (RDH) in order to assess the appropriateness o f empirical antibiotic therapy. Methods: A retrospective review of cases of febrile neutropenia secondary t o malignancy or chemotherapy occurring at the RDH over the period 1994-99. In order to compare infections in this group with those in the wider hospit al community, all positive blood cultures in the medical and intensive care units were reviewed for the same time period. Results: Thirty-six episodes of febrile neutropenia were reviewed. Staphylo coccus aureus (predominantly methicillin resistant), Pseudomonas aeruginosa and Escherichia coli were the most common organisms identified. Nine patie nts died of their infection, four with methicillin-resistant S. aureus bact eraemia. S. aureus, E. coli, Streptococcus pneumoniae and Burkholderia pseu domallei (melioid) were the most frequently isolated organisms from blood c ultures taken in the medical and intensive care units. Conclusions: Gram-positive organisms are the predominant pathogens in febri le neutropenic episodes at the RDH. Standard empirical therapy with an exte nded-spectrum penicillin and an aminoglycoside remains appropriate, with th e addition of vancomycin when clinical status fails to improve. When practi sing in the Top End, particular consideration should be given to skin integ rity and scabies and testing for Strongyloides in Aboriginal patients.