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Microbial blood culture patterns and antibiotic susceptibility in pediatric febrile neutropenia at Sanglah General Hospital Bali

Background: Febrile neutropenia is defined as a fever with a temperature more than or equal to 38.3°C in two measurements within 24 hours and accompanied by severe neutropenia (≤500/μL). Gram-positive bacteria have been the most common cause of febrile neutropenia in children for the previous two decades. However, the contradiction in some studies reported that gram-negative bacteria were the main pathogens causing infection. Because there are differences and shifts in the bacterial spectrum, information on the bacterial pattern and antibiotic susceptibility is critical to reaching the optimal management of febrile neutropenia patients.
Methods: This observational, descriptive study was conducted in Sanglah Hospital, Bali, Indonesia, involving pediatric patients (<18 years old) with febrile neutropenia. Data on antibiotic susceptibility and microbial patterns were collected retrospectively from the blood culture registry taken from febrile neutropenia patients from October 2017 to August 2020. Collected data were analyzed using the SPSS program for Windows, version 21.0. Univariate analysis was conducted, and data with a categorical scale were reported in frequency distribution and percentage, then displayed in a table and graph.
Result: A total of 180 episodes of febrile neutropenia were collected from 89 patients. Among 180 blood cultures, there were found 44 (24.44%) blood cultures with positive results. A higher proportion of gram-negative organisms (33; 75%) is found compared to gram-positive organisms (11; 25%). The susceptibility rates were 100% for Azithromycin, Amoxicillin Clavulanate, Cefoperazone Sulbactam, Meropenem, Linezolid, and Doxycycline, while Cefepime, the previous empirical antibiotic, was susceptible at 79.31% isolates.
Conclusion: Gram-negative bacteria were the most frequent cause of infection among febrile neutropenic patients. Although the research evidence is still weak due to the small sample size, Cefoperazone Sulbactam could be a better option to replace Cefepime as an empirical antibiotic due to its significantly higher susceptibility.