Original Articles
Vol. 18 No. 1 (2026): Mediterranean Journal of Hematology and Infectious Diseases
FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGICAL MALIGNANCIES: PATHOGEN DISTRIBUTION, RESISTANCE PATTERNS, AND PREDICTORS OF 28-DAY MORTALITY
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: October 31, 2026
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Background: Patients with hematological malignancies remain particularly vulnerable to severe infections, and the management of febrile neutropenia (FN) is increasingly challenged by the rising burden of multidrug-resistant pathogens, especially in high-resistance settings.
Objectives: To evaluate causative pathogens, antimicrobial resistance patterns, and independent predictors of 28-day infection-related mortality in FN episodes among adults with hematological malignancies.
Methods: We retrospectively reviewed 240 FN episodes from 170 adult patients followed at a tertiary university hospital between April 2022 and September 2024. Independent predictors of infection-related mortality were identified using multivariable logistic regression with generalized estimating equations.
Results: Fever of unknown origin accounted for 45.4% of episodes, clinically documented infection for 29.2%, and microbiologically documented infection for 25.4%. Gram-negative bacteria predominated among culture-positive episodes (76.0%), with Escherichia coli (45.3%) and Klebsiella spp. (24.0%) as the most frequent isolates. Resistance to third-generation cephalosporins and carbapenems in Klebsiella reached 83.3% and 77.8% (14/18), respectively. No Pseudomonas aeruginosa or methicillin-resistant Staphylococcus aureus was recovered. All Candida isolates were fluconazole-resistant, while none showed resistance to echinocandins or amphotericin B. Invasive pulmonary aspergillosis developed in 21 episodes (8.8%). The 28-day infection-related mortality was 22.4% (38/170). On multivariable analysis, low baseline platelet count (OR=0.988; p=0.014), low lymphocyte count (OR=0.163; p=0.037), and prolonged neutropenia (OR=1.018; p=0.018) emerged as independent mortality predictors.
Conclusions: The high carbapenem resistance in Klebsiella and universal fluconazole resistance among Candida isolates reflect a substantial resistance burden. Low platelet count, low lymphocyte count, and prolonged neutropenia emerged as independent mortality predictors, underscoring the need for empirical strategies guided by local surveillance and individualized risk-based approaches.
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Febrile neutropenia; hematological malignancies; antimicrobial resistance; carbapenem resistance; mortalityHow to Cite
“FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGICAL MALIGNANCIES: PATHOGEN DISTRIBUTION, RESISTANCE PATTERNS, AND PREDICTORS OF 28-DAY MORTALITY” (2026) Mediterranean Journal of Hematology and Infectious Diseases, 18(1), p. e2026082. doi:10.4084/MJHID.2026.082.
Copyright (c) 2026 Rukiyye Bulut, İbrahim Erayman, Ceren Eryılmaz Yaman, Bahar Kandemir, Pınar Belviranlı Keskin, Esma Kepenek Kurt, Özcan Çeneli
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