El Assaad Nassar, Azzi Akel, Haddad Francois, Lebbos Joe, Haddad Elie, Chehata Nabil, Choucair Jacques, Saliba Gebrael
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Department of Infectious Diseases, Hôtel-Dieu de France, Saint Joseph University of Beirut, Beirut, Lebanon.
IJID Reg. 2025 Jun 11;16:100682. doi: 10.1016/j.ijregi.2025.100682. eCollection 2025 Sep.
Febrile neutropenia (FN) is a serious complication of chemotherapy, especially in hematologic malignancies, and carries significant risk of morbidity and mortality risks. Infections, often originating from endogenous flora, are common, with gram-positive and gram-negative bacteria being the predominant pathogens. This systematic review, registered in PROSPERO (ID: CRD420241008055) examines FN incidence, characteristics, infections, and treatment outcomes in the Middle East and North Africa. A total of 22 studies from nine countries, covering 2864 patients and 3245 FN episodes, were included. Bloodstream infections were the most common source, with gram-negative pathogens more prevalent in solid tumors and gram-positive in hematologic malignancies. Empirical antibiotic choices varied significantly across countries, with piperacillin-tazobactam being the most commonly used. However, antimicrobial resistance, particularly from multidrug-resistant organisms, posed significant challenges. Mortality rates reached 12.5%, influenced by healthcare access and antimicrobial resistance. The findings highlight regional disparities in FN management and emphasize the need for tailored antimicrobial stewardship programs, rapid diagnostics, and standardized treatment protocols to improve patient outcomes.
发热性中性粒细胞减少症（FN）是化疗的一种严重并发症，尤其是在血液系统恶性肿瘤中，具有显著的发病和死亡风险。感染通常源于内源性菌群，很常见，革兰氏阳性菌和革兰氏阴性菌是主要病原体。这项在PROSPERO（注册号：CRD420241008055）注册的系统评价研究了中东和北非地区FN的发病率、特征、感染情况及治疗结果。共纳入了来自9个国家的22项研究，涵盖2864例患者和3245次FN发作。血流感染是最常见的感染源，革兰氏阴性病原体在实体瘤中更为普遍，而革兰氏阳性菌在血液系统恶性肿瘤中更为常见。各国经验性抗生素的选择差异很大，哌拉西林-他唑巴坦是最常用的。然而，抗菌药物耐药性，尤其是多重耐药菌带来的耐药性，构成了重大挑战。死亡率达到12.5%，受到医疗可及性和抗菌药物耐药性的影响。研究结果突出了FN管理方面的地区差异，并强调需要制定针对性的抗菌药物管理计划、快速诊断方法和标准化治疗方案，以改善患者预后。
