English abstract
Background: Neutropenia is the most significant risk factor for infection in cancer patients treated with chemotherapy, especially hematological malignancies. Therefore, international guidelines recommend immediate initiation of empirical antibiotic therapy. There is no data on the incidence or the management of febrile neutropenia (FN) in cancer patients treated by chemotherapy in Oman. The aim of this study is to describe the pattern of antimicrobial therapy for FN in patients with hematological malignancies at Sultan Qaboos University Hospital (SQUH).
Methods: A retrospective observational study of the antimicrobial therapy for FN episodes in patients with hematological malignancies from adult hematology, pediatric hematology and adult oncology at SQUH, during the period between January 2007 and February 2010 using patients' medical records.
Results: A total of 176 FN episodes in 107 patients were analyzed. During the analysis period 64% of the patients had two episodes. About 68% of episodes had severe neutropenia. The duration of neutropenia was less than one week in most of the episodes (57%). FN developed during the hospital stay in 57% of the episodes and lead to hospital admission in the remaining 43%. The mean duration of treatment was approximately seven days with no significant difference between specialties or the different types of malignancies. Only 34 (19%) of the episodes had positive cultures, mostly from blood (30 episodes; 88%). The majority of isolates were gram negative organisms (63%). The initial empirical treatment ranged from monotherapy to triple therapy with 37% treated by monotherapy, 60% by dual therapy, and only 3 % by triple therapy. There was significant variation in the choice of the initial empirical antimicrobial drugs between the three specialties managing these episodes.
Conclusions: There is variation in the antimicrobial treatment of FN episodes in patients with hematological malignancies among the three different specialties at SQUH. However, all the used antimicrobials were within the international guidelines and recommendations.
