[Bacteremia with granulocytopenia--microbiology and empiric antibiotic treatment]

Abstract

This article sums up a retrospective analysis of 84 episodes of bacteraemia in acute leukaemia patients with severe neutropenia in a Norwegian teaching hospital during the period 1990-95. Gram negative bacteria represented 54% of the blood culture isolates, all of which were susceptible to aminoglycosides, and nearly all to ceftazidime and imipenem. Penicillin/aminoglycoside was used as initial therapy in 43% of the episodes. Initial empiric therapy was modified in 52% of the events. Only 15% of patients receiving the penicillin/aminoglycoside combination actually had infections with organisms susceptible to penicillin. Only 2% of patients with gram negative infections received initial synergistic treatment with two effective drugs. Mortality from infections was 8% in acute leukaemia patients with documented bacteraemia. Deaths mainly occurred in patients with terminal leukaemia disease. Late breakthrough bacteraemias with Stenotrophomonas maltophilia and Pseudomonas aeruginosa caused 50% of all fatal infections. The analysis suggests that no patients died during initial bacteraemia with penicillin-resistant organisms treated with penicillin/aminoglycoside. The antibiotic susceptibility of the isolated bacteria was favourable compared to what has been found in other countries. For the time being, we believe that the ecological advantages of using penicillin/aminoglycoside as initial empiric treatment of febrile neutropenia are greater than the disadvantages.