Objective: To determine the effect of appropriate antimicrobial therapy (AAT) on mortality among Thai hematological cancer patients with febrile neutropenia (FN).
Material and Method: A 6-year retrospective cohort study of hematological cancer patients receiving chemotherapy from January 2008 to December 2013. Risk factors associated with mortality and the effect of AAT on mortality were determined.
Results: Of 893 chemotherapy episodes from 145 patients, FN occurred in 133 episodes (14.9%) from 67 patients. Of these 133 episodes, 61.6% were female and mean age was 47.9 years. Infections with multidrug-resistant organisms (MDROs) occurred in 18.8% and extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae were the most common MDROs. Among the 133 episodes, 100 (75.2%) were given AAT. Overall mortality rate was 20.3%. No receipt of AAT [adjusted odds ratio (aOR) 9.54; p = 0.041], Multinational Association for Supportive Care in Cancer score of less than 21 points (aOR 4.37; p = 0.021), and systemic inflammatory response syndrome score of 4 (aOR 13.02; p = 0.037) were independent factors associated with mortality.
Conclusion: AAT was associated with reduced mortality in hematological cancer patients with febrile neutropenia. Empirical antimicrobials for FN should be active against ESBL-producing bacteria in this setting where these MDROs are endemic.

Keywords: Febrile neutropenia, Hematologic cancer, Mortality, Appropriate antimicrobials, Multidrug resistance