Bloodstream Infections in Febrile Neutropenic Patients Post Bone Marrow Transplantation, Microbial Profile and Antimicrobial Susceptibility Patterns

Abstract

ABSTRACT

Background: Bloodstream infections remain a significant cause of morbidity and mortality in febrile neutropenic patients undergoing bone marrow transplantation.
Objective: This study aimed to identify the microbial profile and antimicrobial susceptibility patterns in bone marrow transplantation recipients with febrile neutropenia at a tertiary care center.
Methods: A retrospective analysis of blood culture results and antimicrobial susceptibility patterns was conducted from 16 febrile neutropenic patients who underwent bone marrow transplantation at Montaserieh Hospital in Mashhad, Iran. Demographic data, presence of central venous catheters, isolated microorganisms, and antibiotic susceptibility profiles were analyzed.
Results: The majority of patients were female (62.5%) and under 10 years of age (37.5%). All patients had central venous catheters. Gram-positive bacteria predominated (68.7%), with Staphylococcus epidermidis being the most common isolate (25%), followed by Enterococcus spp. (18.8%). Among Gram-negative bacteria, Klebsiella pneumoniae was most prevalent (18.8%). All infections were monomicrobial, with no polymicrobial or fungal infections detected. Gram-negative isolates showed highest resistance to levofloxacin, cefazolin, and cotrimoxazole, while remaining highly susceptible to imipenem. Gram-positive bacteria exhibited highest resistance to oxacillin, with preserved susceptibility to vancomycin, linezolid, and gentamicin.
Conclusion: Gram-positive cocci, particularly coagulase-negative staphylococci, are the predominant cause of bloodstream infections in febrile neutropenic bone marrow transplantation patients, likely associated with central venous catheter use. The observed resistance patterns have important implications for empiric antimicrobial therapy, suggesting that vancomycin or linezolid combined with carbapenems may be appropriate initial treatment for febrile neutropenia in this population. Implementing antimicrobial stewardship and improving catheter care practices are essential strategies to address these findings.

kEYWORDS: Febrile neutropenia; Bone marrow transplantation; Antimicrobial resistance; Antimicrobial Susceptibility; Microbial Profile; Central venous catheter