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Background <p>Concurrent bacteremia in febrile neutropenia is associated with increased mortality, but there is limited data regarding the impact of neutropenia severity on patient outcomes.</p> Methods <p>A retrospective cohort study was conducted among adults (age &gt; 18) with hematologic or solid malignancies who developed neutropenic bacteremia and received definitive cefepime treatment for &gt; 48&#xa0;h. Those who had severe neutropenia (absolute neutrophil count [ANC] 100–500 cells/µL) or profound neutropenia (ANC &lt; 100 cells/µL) were included in the analysis. Cox proportional hazards model was used to determine the independent predictors of 30-day mortality.</p> Results <p>The study included 200 bacteremias with an overall mortality rate of 13.5%. There was no difference in mortality between the profound and severe neutropenia groups (11.3% vs. 20.0%; <i>P</i> = 0.121). After adjusting for the confounding factors, profound neutropenia was not associated with 30-day mortality (adjusted hazard ratio [aHR] 0.73; 95% CI, 0.31–1.75; <i>P</i> = 0.484). Major predictors of 30-day mortality were pneumonia as the infection source (aHR 3.81; 95% CI, 1.23–11.78), higher Pitt bacteremia scores (aHR 1.26 per point), and increased Charlson comorbidity index (aHR 1.27 per point). Notably, patients with solid tumors had significantly higher 14-day mortality compared to those with hematologic malignancies (16.9% vs. 7.0%; <i>P</i> = 0.029). A relatively longer length of stay was observed in the profound neutropenia group (<i>P</i> = 0.096).</p> Conclusions <p>In patients with neutropenic bacteremia treated with appropriate antibiotics, the severity of neutropenia is not associated with 30-day mortality. Our findings suggest that the potential risk associated with profound neutropenia may be mitigated by the appropriate antimicrobial therapy.</p>

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Does the severity of neutropenia affect mortality in bacteremic cancer patients?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月16日

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  • Peng-Hao Chang,
  • Po-Yen Huang,
  • Shian-Sen Shie,
  • Hsuan-Ling Hsiao,
  • Yi-Jiun Su,
  • Chun-Fu Yeh,
  • Ching-Tai Huang

摘要

Background

Concurrent bacteremia in febrile neutropenia is associated with increased mortality, but there is limited data regarding the impact of neutropenia severity on patient outcomes.

Methods

A retrospective cohort study was conducted among adults (age > 18) with hematologic or solid malignancies who developed neutropenic bacteremia and received definitive cefepime treatment for > 48 h. Those who had severe neutropenia (absolute neutrophil count [ANC] 100–500 cells/µL) or profound neutropenia (ANC < 100 cells/µL) were included in the analysis. Cox proportional hazards model was used to determine the independent predictors of 30-day mortality.

Results

The study included 200 bacteremias with an overall mortality rate of 13.5%. There was no difference in mortality between the profound and severe neutropenia groups (11.3% vs. 20.0%; P = 0.121). After adjusting for the confounding factors, profound neutropenia was not associated with 30-day mortality (adjusted hazard ratio [aHR] 0.73; 95% CI, 0.31–1.75; P = 0.484). Major predictors of 30-day mortality were pneumonia as the infection source (aHR 3.81; 95% CI, 1.23–11.78), higher Pitt bacteremia scores (aHR 1.26 per point), and increased Charlson comorbidity index (aHR 1.27 per point). Notably, patients with solid tumors had significantly higher 14-day mortality compared to those with hematologic malignancies (16.9% vs. 7.0%; P = 0.029). A relatively longer length of stay was observed in the profound neutropenia group (P = 0.096).

Conclusions

In patients with neutropenic bacteremia treated with appropriate antibiotics, the severity of neutropenia is not associated with 30-day mortality. Our findings suggest that the potential risk associated with profound neutropenia may be mitigated by the appropriate antimicrobial therapy.