DCK Chiu, SY Ha, PL Ho, S Wong, YL Lau

Background Febrile neutropenia (FNE) is a common chemotherapy-induced problem in oncology patients. Early antibiotic treatment is important to prevent fatal infection. Various antibiotic regimes have been used both in adult and paediatric oncology patients. The best regime should be the one which covers the most common and fatal organisms prevalent in the local setting. When the coverage is similar among different regimes, the cost of antibiotics would be another consideration.

Aims This review aims at identifying the causative organisms and the antibiotics sensitivity pattern in paediatrics oncology patients admitted with FNE during the period from 1/1/93 to 30/6/95.

Method Records of patient with a diagnosis of neutropenic fever and with a primary diagnosis of oncology diseases were retrieved in the mentioned period. Positive cultures (in peripheral and central line blood) sent iii the same period were retrieved from the Microbiology Department Database. Duration of fever, antibiotics used and absolute neutrophil counts (ANC) were also reviewed.

Findings There were total 97 febrile neutropenia episodes occurring in 20 patients. 34% (33/97) the FNE had positive blood cultures. The two most common causative organisms were Staphylococcal species (57%-- Staph. aureus 19.6%, Coag-ve staph 35.7% and Staph. epidermidis 7.1%) and Bacillus species (16%-- Bacil. cereus 12.5%, Bacil. sp. 3.6%). Other organisms included Strept. pneumonia, Strept. viridans, Acinobacter iwoffii, Acinobacter anitratus, E. Coli, Diphth. bacilli, Kleb. pneumonia, H. influenzae, Propionibacterium acnes, Agrobacterium radiobacter. Regarding the overall isolates 66% were methicillin resistant. 18% were resistant to aminoglycosides and 18% of the isolates were not sensitive to vancomycin. 25% of the Staphylococcal isolates were methicillin resistant.

Conclusion Staphylococcal infections are common among paediatric oncology patients with febrile neutropenia and resistance to common antibiotics might become a problem. Further prospective evaluation of different regimes can give a better and more cost effective treatment protocol.