• Mical Paul, Anat Gafter-Gvili, Leonard Leibovici, Jihad Bishara, Itzhak Levy, Isaac Yaniv, Itamar Shalit, Zmira Samra, Silvio Pitlik, Hanna Konigsberger, and Miriam Weinberger.
• Department of Medicine E, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel. pil1pel@zahav.net.il
• Isr Med Assoc J. 2007 Jun 1;9(6):424-9.

BackgroundThe epidemiology of bacteremic febrile neutropenia differs between locations and constitutes the basis for selection of empiric antibiotic therapy for febrile neutropenia.ObjectivesTo describe the epidemiology of bacteremia among patients with neutropenia in a single center in Israel.MethodsWe conducted a prospective data collection on all patients with neutropenia (< 500/mm3) and clinically significant bacteremia or fungemia during the period 1988-2004.ResultsAmong adults (462 episodes) the most common bloodstream isolate was Escherichia coli. Gram-negative bacteria predominated throughout the study period and the ratio between Gram-negative and Gram-positive bacteremia increased from 1.7 to 2.3. Among children (752 episodes), the ratio between Gram-negative and Gram-positive bacteremia reversed from 1.2 to 0.7, due to increasing prevalence of coagulase-negative staphylcoccal bacteremia. Both among adults and children, the length of hospital stay prior to bacteremia had a major impact on the pathogens causing bacteremia and their antibiotic susceptibilities. The prevalence of E. coli decreased with time in hospital, while the rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp., Enterococcus spp. and Candida spp. increased. Resistance to broad-spectrum empiric monotherapy in our center was observed in > 40% of Gram-negative bacteria when bacteremia was acquired after 14 days in hospital.ConclusionsImproved infection-control measures for neutropenic cancer patients in our center are needed. Empiric antibiotic treatment should be tailored to patients' risk for multidrug-resistant organisms. Individual hospitals should monitor infection epidemiology among cancer patients to guide empiric antibiotic treatment.

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