The approach of hematologists toward managing neutropenic fever in patients with hematological malignancies: Insights from the Iraqi experience

BACKGROUND: Febrile neutropenia (FN) is a medical emergency commonly observed in patients undergoing chemotherapy for hematological malignancies, and without timely administration of broad-spectrum antibiotics, infections can quickly worsen within the first few hours of fever onset. Due to the immunosuppressed state of these patients, FN demands immediate evaluation and management to prevent severe complications, including severe illness and death. OBJECTIVES: The study aimed to evaluate the perspectives and approaches of Iraqi hematologists in treating neutropenic fever in patients with hematological diseases. MATERIALS AND METHODS: This study is an observational cross-sectional study that included patients with FN while undergoing chemotherapy for various acute and chronic hematological malignancies. The study population was drawn from hematology wards in different centers in Baghdad and Al-Nasiriya, where cases of FN were routinely managed. RESULTS: The study enrolled 100 patients with FN, with a mean age of 41.53 years (±9.3 years). Among them, 21% had acute lymphoblastic leukemia (ALL), and 26% had acute myeloid leukemia (AML). Regarding empiric antibiotic therapy, 56% of patients were treated with combination antibiotics, while 44% received monotherapy. Infections were most commonly identified in the gastrointestinal tract (34%) and skin (23%), with less frequent involvement of the lungs. In 20% of cases, the infection source remained unidentified despite the presence of bloodstream infections. Cultures of the blood were positive in 25% of patients, while 75% had negative results. No significant association was found between neutrophil count and blood culture positivity or between blood culture results and different underlying hematological diagnoses. CONCLUSION: Severe neutropenia was closely linked to a higher risk of infection, particularly in patients with AML and ALL. The decision to use mono or combination antibiotic therapy varied based on hematologists’ preferences and drug availability. Gastrointestinal and skin infections were the most frequently documented infection sites. These findings underscore the need for improved infection prevention strategies in this vulnerable population.