Febrile neutropenia in the Middle East and North Africa Region: trends, management, and outcomes (2000-2024)-A systematic review.

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.