Emergence of MRSA in positive blood cultures from patients with febrile neutropenia—a cause for concern
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
- 3.Klastersky J, Aoun M (2004) Opportunistic infections in patients with cancer. Ann Oncol 15:329–335Google Scholar
- 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.Irish European Antimicrobial Resistance Surveillance System Steering Group (EARSS) EARSS Report for Quarter 1 2007 (Ireland). Health Services Executive, Health Protection Surveillance Centre, Dublin, http://www.ndsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2007Reports/
- 16.National Cancer Institute (2003) Common terminology criteria for adverse events v3.0 (CTCAE). National Cancer Institute, Bethesda, www.cancer.gov
- 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