Emergence of MRSA in positive blood cultures from patients with febrile neutropenia—a cause for concern
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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.
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.
KeywordsFebrile neutropenia MRSA VRE Blood cultures
methicillin-resistant Staphylococcus aureus
- S. aureus
The authors would like to thank Maurice Mallen for his assistance in reviewing the laboratory data.
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