Supportive Care in Cancer

, Volume 16, Issue 9, pp 1085–1088 | Cite as

Emergence of MRSA in positive blood cultures from patients with febrile neutropenia—a cause for concern

  • Patrick G. Morris
  • Tidi Hassan
  • Mairead McNamara
  • Astrid Hassan
  • Rebecca Wiig
  • Liam Grogan
  • Oscar S. Breathnach
  • Edmond Smyth
  • Hilary Humphreys
Original Article


Goals of work

Febrile neutropenia (FN) causes considerable morbidity in patients on cytotoxic chemotherapy. Recently, there has been a trend towards fewer Gram-negative and more Gram-positive infections with increasing antibiotic resistance. To assess these patterns, data from a supra-regional cancer centre in Ireland were reviewed.

Patients and methods

A 5-year review of all positive blood cultures in patients undergoing anti-cancer chemotherapy was carried out.

Main results

Eight hundred and ninety-four patients were reviewed. The mean incidence of FN was 64.2 cases per year. Eight hundred and forty-six blood culture specimens were taken and 173 (20.4%) were culture positive. The isolated organisms were Gram positive (71.1%), Gram negative (27.8%) and fungal (1.1%). Of the Gram-positive organisms, 75.6% were staphylococci. Of these, 67.8% were coagulase-negative staphylococci and 30.1% were Staphylococci aureus. Amongst the S. aureus, 89.3% were methicillin-resistant (MRSA). Vancomycin-resistant enterococci were not identified as a cause of positive blood cultures.


Amongst patients with cancer who develop FN in our hospital, Gram-positive bacteria account for the largest proportion. The high proportion of MRSA as a cause of positive blood cultures is of concern.


Febrile neutropenia MRSA VRE Blood cultures 



febrile neutropenia


methicillin-resistant Staphylococcus aureus


vancomycin-resistant enterococci


colony-stimulating factors

S. aureus

Staphylococcus aureus



The authors would like to thank Maurice Mallen for his assistance in reviewing the laboratory data.


  1. 1.
    Sipsas NV, Bodey GP, Kontoyiannis DP (2005) Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 103:1103–1113PubMedCrossRefGoogle Scholar
  2. 2.
    Rolston KV (2005) Challenges in the treatment of infections caused by Gram-positive and Gram-negative bacteria in patients with cancer and neutropenia. Clin Infect Dis 40:S246–S252PubMedCrossRefGoogle Scholar
  3. 3.
    Klastersky J, Aoun M (2004) Opportunistic infections in patients with cancer. Ann Oncol 15:329–335Google Scholar
  4. 4.
    Smith PF, Birmingham MC, Noskin GA et al (2003) Safety, efficacy and pharmacokinetics of linezolid for treatment of resistant Gram-positive infections in cancer patients with neutropenia. Ann Oncol 14:795–801PubMedCrossRefGoogle Scholar
  5. 5.
    Elting LS, Rubenstein EB, Rolston K et al (2000) Time to clinical response: an outcome of antibiotic therapy of febrile neutropenia with implications for quality and cost of care. J Clin Oncol 18:3699–3706PubMedGoogle Scholar
  6. 6.
    Gonzalez-Barca E, Fernandez-Sevilla A, Carratala J et al (1996) Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institution. Eur J Clin Microbiol Infect Dis 15:291–296PubMedCrossRefGoogle Scholar
  7. 7.
    Tomiak AT, Yau JC, Huan SD et al (1994) Duration of intravenous antibiotics for patients with neutropenic fever. Ann Oncol 5:441–445PubMedGoogle Scholar
  8. 8.
    Mathur P, Chaudhry R, Kumar L et al (2002) A study of bacteremia in febrile neutropenic patients at a tertiary-care hospital with special reference to anaerobes. Med Oncol 19:267–272PubMedCrossRefGoogle Scholar
  9. 9.
    Pizzo PA (1993) Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 328:1323–1332PubMedCrossRefGoogle Scholar
  10. 10.
    McDonald P, Mitchell E, Johnson H et al (2003) Epidemiology of MRSA: the North/South study of MRSA in Ireland 1999. J Hosp Infect 54:130–134PubMedCrossRefGoogle Scholar
  11. 11.
    MacKenzie FM, Bruce J, Struelens MJ et al (2007) ARPAC Steering Group. Antimicrobial drug use and infection control practices associated with the prevalence of methicillin-resistant Staphylococcus aureus in European hospitals. Clin Microbiol Infect 13:269–276PubMedCrossRefGoogle Scholar
  12. 12.
    Reynolds R, Potz N, Colman M et al (2004) BSAC extended working party on bacteraemia resistance surveillance. Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001–2002: the BSAC Bacteraemia Resistance Surveillance Programme. J Antimicrob Chemother 53:1018–1032PubMedCrossRefGoogle Scholar
  13. 13.
    Irish European Antimicrobial Resistance Surveillance System Steering Group (EARSS) EARSS Report for Quarter 1 2007 (Ireland). Health Services Executive, Health Protection Surveillance Centre, Dublin,
  14. 14.
    Smith TJ, Khatcheressian J, Lyman GH et al (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24:3187–3205PubMedCrossRefGoogle Scholar
  15. 15.
    Aapro MS, Cameron DA, Pettengell R et al (2006) EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 42:2433–2453PubMedCrossRefGoogle Scholar
  16. 16.
    National Cancer Institute (2003) Common terminology criteria for adverse events v3.0 (CTCAE). National Cancer Institute, Bethesda,
  17. 17.
    Pizzo PA, Ladisch S, Simon RM et al (1978) Increasing incidence of Gram-positive sepsis in cancer patients. Med Pediatr Oncol 5:241–244PubMedCrossRefGoogle Scholar
  18. 18.
    Paul M, Borok S, Fraser A et al (2005) Additional anti-Gram-positive antibiotic treatment for febrile neutropenic cancer patients. Cochrane Database Syst Rev (3) Art. No.: CD003914. DOI  10.1002/14651858.CD003914.pub2
  19. 19.
    Gopal AK, Fowler VG Jr, Shah M et al (2000) Prospective analysis of Staphylococcus aureus bacteremia in nonneutropenic adults with malignancy. J Clin Oncol 18:1110–1115PubMedGoogle Scholar
  20. 20.
    Figuera Esparza M, Carballo M, Silva M et al (2006) Microbiological isolates in patients with febrile neutropenia and hematological neoplasias. Rev Esp Quimioter 19:247–251PubMedGoogle Scholar
  21. 21.
    Paul M, Yahav D, Fraser A, Leibovici L (2006) Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 57:176–189PubMedCrossRefGoogle Scholar
  22. 22.
    Paul M, Borok S, Fraser A et al (2005) Empirical antibiotics against Gram-positive infections for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 55:436–444PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Patrick G. Morris
    • 1
    • 3
  • Tidi Hassan
    • 1
  • Mairead McNamara
    • 1
  • Astrid Hassan
    • 1
  • Rebecca Wiig
    • 1
  • Liam Grogan
    • 1
  • Oscar S. Breathnach
    • 1
  • Edmond Smyth
    • 2
  • Hilary Humphreys
    • 2
  1. 1.Department of OncologyBeaumont HospitalDublinIreland
  2. 2.Department of MicrobiologyBeaumont Hospital and Royal College of Surgeons in IrelandDublinIreland
  3. 3.Cancer Clinical Trials Office, Cancer CentreBeaumont HospitalDublinIreland

Personalised recommendations