Etiology, Risk Factors, and Outcomes of Bacteremia in Patients With Hematologic Malignancies and Febrile Neutropenia in Uganda

Abstract

Background We determined the etiology, risk factors and outcomes associated with bacteremia in patients with hematologic malignancies and febrile neutropenia (FN) at the Uganda Cancer Institute (UCI). Methods UCI adult and pediatric inpatients with hematologic malignancies and FN were prospectively enrolled and followed up to determine 30-day mortality. Blood drawn from participants with FN was cultured in the BACTEC 9120 blood culture system. Antimicrobial susceptibility testing was performed with the disk diffusion method on identified bacteria. Logistic regression and Cox proportional hazards regression were applied to estimate associations between participant characteristics and FN, bacteremia, and mortality. Results Of 495 participants, majority (N=306, 62%) were male. Median age was 23 years (IQR:11-42 years). Of the 132 participants who experienced FN, 43 (33%) had bacteremia. Participants with younger age (OR:0.98, p=0.05), severe neutropenia (OR: 2.9, p=0.01), hypotension (OR: 2.46, p=0.04), mucositis (OR: 2.77, p=0.01) and receiving chemotherapy (OR:2.25, p=0.03) were more likely to have bacteremia. Fifty (78%) bacteria isolated were Gram negative. E. coli (n=25, 50%) was predominant. Thirty-seven (86%) out of 43 episodes were caused by multidrug resistant (MDR) bacteria. 30-day overall survival for participants with bacteremia was significantly lower than that for participants with no bacteremia (p=0.05). MDR bacteremia (HR=1.84, p=0.05) was associated with increased risk of death. Conclusion Bacteremia was frequent in patients with hematologic cancer and FN and was associated with poor survival. MDR bacteria were the main cause of bacteremia and mortality. There is a need for robust infection control and antimicrobial stewardship programs in cancer centers in sub-Saharan Africa.