Background: Infection in patients with chemotherapy-induced neutropenia is a serious complication that causes significant morbidity and mortality. Prompt and appropriate antimicrobial therapy improves treatment outcomes. However, mortality rate and complications in patients with febrile neutropenia were still high. Etiologic infectious agents of febrile neutropenia differ among countries and they change periodically.

Objective: To identify the clinical characteristics and etiologic organisms in patients with febrile neutropenia at Siriraj Hospital, and to identify factors that significantly predict patient outcomes

Materials and Methods: The medical records of patients with febrile neutropenia hospitalized at Siriraj Hospital between January 2008 and June 2010 were analyzed. Patient characteristics, epidemiologic data, bacteriologic data, and factors at the onset of fever were collected to predict patient outcomes. The data from this study was compared with data from a similar study conducted at our center in 2000.

Results: Of 234 patients with 310 febrile neutropenic episodes, 80.8% had hematologic malignancies and 19.2% had solid tumors. Mean age of the 105 male and 129 female patients was 46.6±16.3 years. Patients recovered in 43.2% of cases, and the overall mortality rate was 19.7%. Bacteremia was found in 23.9% of cases. Gram-negative bacteria were the most common causative organisms. Compared with data from the study conducted in 2000, there was no significant change in the prevalence of Gram-negative and Gram-positive bacteria. The prevalence of extended-spectrum beta-lactamase [ESBL]-producing gram-negative bacteria is 29.8%. A significant increase in the prevalence of fungemia in febrile neutropenic patients was observed between the 2000 and 2010 study (0% to 6.7%, p = 0.045). Multivariate analysis revealed malignancy type, body temperature, and blood pressure to be factors that independently predict patient outcome.

Conclusion: Consistent with the 2000 study finding, Gram-negative bacteria are still the most common etiologic organisms in febrile neutropenic patients at Siriraj Hospital. However, we found an increase in the proportion of ESBL-producing Gram-negative bacteria and fungal pathogens. Peak temperature of 39°C or higher and hypotension were identified as significant predictors of unfavorable outcomes, including death. Ongoing and vigilant surveillance of changing and emerging organisms is essential for optimizing patient outcomes.

Keywords: Febrile neutropenia, Chemotherapy-induced neutropenia, Fever, Epidemiology, Neutropenic