OBJECTIVE To analyze the pathogenic bacteria and their drug resistance in blood cultures of patients with neutropenia and fever in a hospital over the past 10 years, providing a reference for empirical antibacterial drug therapy and precise prevention and control of the spread of multidrug-resistant bacteria.

METHODS A total of 655 patients with neutropenia and fever admitted to the Hematology Department of Shanghai Changhai Hospital from Jan. 2014 to Dec. 2023 were selected as the study subjects. The blood culture results and drug resistance information of pathogenic bacteria of the patients were retrospectively collected, the distribution and detection rate of drug-resistant bacteria and trend of resistance rate over the years were analyzed.

RESULTS A total of 678 strains of pathogenic bacteria were cultured and isolated from 655 patients, including 463 strains of gram-negative bacteria (68.29%), 183 strains of gram-positive bacteria (26.99%) and 32 strains of fungi (4.72%). The gram-negative bacteria mainly consisted of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. The gram-positive bacteria mainly consisted of coagulase-negative Staphylococci (CNS), Viridans streptococci and Enterococcus faecium. The fungi mainly consisted of Candida tropicalis. The resistance rate of E. coli to carbapenem antibacterial drugs was the highest(6.38%), and no tigecycline-resistant strains were detected. The resistance rate of K. pneumoniae to carbapenem antibacterial drugs was the highest(15.91%), and the tigecycline resistance rate was 9.62%. The resistance rate of P. aeruginosa to carbapenem antibacterial drugs was the highest(12.73%). The oxacillin resistance rate of CNS was 78.18%, and the linezolid resistance rate was low (3.70%), with no vancomycin-resistant strains detected. The penicillin resistance rate of viridans streptococci was 4.17%. E. faecium was sensitive to vancomycin and linezolid. The oxacillin resistance rate of Staphylococcus aureus was 40.00%. There was no statistically significant difference in the constituent ratio of major pathogenic bacteria and the detection rate of common multidrug-resistant bacteria between different years.

CONCLUSIONS For patients with neutropenia and fever, Enterobacteriaceae bacteria such as E. coli and K. pneumoniae should be included in the coverage of empirical antibacterial drug therapy. The prevention and control of opportunistic pathogens such as viridans streptococci and gram-positive aerobic spore-forming bacteria cannot be ignored. When fungal infection is suspected, candida, especially C. tropicalis, should be considered first. In addition, the detection rate of methicillin-resistant S. aureus in blood cultures is high, which should also be given sufficient attention.