Microbiological characterization of bacteremia in patients with chemotherapy-induced febrile neutropenia: systematic review and meta-analysis

Correa A.F.; Guasti P.; Fuenmayor-González L.; Alexander-León H.; Yu Liu Y.; Salgado-Apunte J.E.; González Grijalva J.; Sánchez H.; García-Méndez N.; García-Aguilera M.F. · Therapeutic Advances in Infectious Disease (2025) · DOI: 10.1177/20499361251376123

Resumen

Background: Febrile neutropenia (FN) is the most common and serious adverse event of chemotherapy for solid and hematological neoplasms, with infection as a major complication. FN occurs in 10%–50% of patients with solid tumors and over 80% with hematological malignancies, with mortality rates up to 11%. Objective: To characterize bloodstream pathogens in post-chemotherapy FN through a systematic review and meta-analysis of studies published from 2013 to February 13, 2024. Design: Systematic review and meta-analysis. Data sources and methods: PubMed, Web of Science, Scopus, and Embase were searched using MeSH, Emtree, and keywords. Risk of bias was assessed using the JBI checklist. Random-effects proportions meta-analysis was performed. Results: Twenty-two studies (n = 23,319) reported 8665 positive blood cultures: 59% Gram-negative (95% CI: 46.8–67.5), 39.7% Gram-positive (95% CI: 31.3–48.2), and 2.5% fungi (95% CI: 0.9–4.1). Random-effects meta-analysis showed high heterogeneity (I2 = 98.92%, p < 0.01). Meta-regression by sample size, economic development, and risk of bias did not explain this variability. Conclusion: Gram-negative pathogens slightly predominate over Gram-positives in bloodstream infections among post-chemotherapy FN patients. Trial registration: PROSPERO (CRD42023472191). © The Author(s), 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Instituciones: Universidad Peruana Cayetano Heredia