Work

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

Year: 2026

Type: article

Abstract: 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.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-026-13574-2