Microbiological profile and 30-day mortality outcomes in febrile neutropenia among solid malignancy patients: a multicentre retrospective study from resource-limited setting

Febrile neutropenia (FN) is a life-threatening complication in patients undergoing cancer chemotherapy. This multicentric retrospective study aimed to evaluate the microbiological profile and factors affecting 30-day mortality in FN patients with solid malignancies. FN defined as single episode of oral temperature of > 101 °F (≥ 38.3 °C), with an absolute neutrophil count (ANC) < 500cells/mm³ or ANC which is expected to decrease to < 500cells/mm³ over next 48 h. All episodes of FN data that occurred between May 2021 and April 2023 were collected from three tertiary-care cancer centres and analysed. Among 710 patients who received chemotherapy over two years, 70 (9.8%) experienced FN. Antibiotic therapy was administered according to published guidelines. Of the 106 different cultures analysed, microbiological isolates were obtained from 23 (21.6%) cultures. Gram-negative bacteria were predominant (60.8%), followed by Gram-positive bacteria (30.43%). On the last day of follow-up, 52 (74.28%) patients were alive and 18 (25.71%) were dead. The 30-day mortality was significantly higher in patients with ANC < 500 cells/mm3 at the time of presentation (p = 0.001), who had positive cultures (p = 0.001), who developed FN on first-line chemotherapy (p = 0.020) and patients who did not receive prophylactic G-CSF support (p = 0.001). FN is a serious complication in patients undergoing chemotherapy for solid malignancies. This study identifies microbiological patterns and factors associated with higher 30-day mortality in FN among solid malignancy patients, suggesting areas for improved early recognition and tailored management.