{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:03:29Z","timestamp":1785301409047,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Neutropenia is a major obstacle in the care of cancer patients. It is common in patients receiving chemotherapy, associated with significant morbidity and mortality, it occurs in 5-30% among patients with solid tumors and exceeds 80% of those undergoing chemotherapy for hematologic malignancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study primary endpoint was to assess the clinical outcome of the different antibiotic regimens. The secondary endpoint was to assess the microbiological appropriateness of antibiotic coverage of our carbapenem-sparing empiric regimen for neutropenic fever in patients admitted to the hemato-oncology departments to Augusta Victoria Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients data were extracted from the hospital health information system for all entries pertaining to neutropenic fever from 1 January 2022 to 30 November 2025. Statistical comparison between empiric antibiotic regimens was not performed because treatment escalation followed a predefined sequential protocol, resulting in non-independent groups. Assessment of antimicrobial appropriateness was completed using IBM SPSS Statistics via Fisher\u2019s Exact Test. Patient data analyzed, included antibiotic classes used, bacterial culture results, antimicrobial sensitivity testing, cause of fever and outcome of antimicrobial treatment. Exclusions criteria included prophylaxis prescriptions for neutropenic fever and pediatric patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 208 patients with febrile neutropenia were evaluated between January 1st, 2022, to November, 2025\n                      <jats:sup>th<\/jats:sup>\n                      2025. Hematology patients represented a major proportion compared to oncology (56.70% and 43.30%, respectively). Our institutional protocol, represented by ceftazidime and amikacin (the last is replaced with ciprofloxacin for patients with renal failure) was the most prescribed regimen (78.1%), followed by piperacillin-tazobactam \u00b1 vancomycin (16.4%) and finally meropenem (5.5%). Our institutional regimen was theoretically appropriate in 44.4% of cases, compared to piperacillin-tazobactam \u00b1 vancomycin (55.6%) and meropenem (88.9%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The institutional stepwise empiric antibiotic protocol demonstrated high overall clinical response rates in patients with febrile neutropenia, with most patients achieving improvement without requiring escalation beyond first-line therapy. Simulated microbiological assessment suggested increasing pathogen coverage with broader-spectrum regimens, although this should be interpreted cautiously given the limited number of positive culture isolates. These findings support the effectiveness of the current protocol while emphasizing the importance of balancing microbiological coverage with antimicrobial stewardship principles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1876292","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:44:51Z","timestamp":1785300291000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Empiric antibiotic regimen for febrile neutropenia in cancer patients: a tertiary oncology center experience"],"prefix":"10.3389","volume":"16","author":[{"given":"Hasan","family":"Arafat","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Augusta Victoria Hospital","place":["East Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marah","family":"Sabateen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Holy Family Hospital","place":["Bethlehem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Sadaqa","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Augusta Victoria Hospital","place":["East Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammam","family":"Rjoup","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Augusta Victoria Hospital","place":["East Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Shoeibat","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Augusta Victoria Hospital","place":["East Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musa","family":"Hindiyeh","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Augusta Victoria Hospital","place":["East Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Sabateen","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Augusta Victoria Hospital","place":["East Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2017.06.016","article-title":"Empiric antibiotic protocols for cancer patients with neutropenia: a single\u2013center study of treatment efficacy and mortality in patients with bacteremia","volume":"51","author":"Kleinhendler","year":"2018","journal-title":"Int J Antimicrob Agents"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-120-10-199405150-00004","article-title":"Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer: a multicenter randomized trial","volume":"120","author":"De Pauw","year":"1994","journal-title":"Ann Internal Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir073","article-title":"Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America","volume":"52","author":"Freifeld","year":"2011","journal-title":"Clin Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1200\/jop.18.00016","article-title":"Outpatient management of fever and neutropenia in adults treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update","volume":"36","author":"Taplitz","year":"2018","journal-title":"J Clin Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdq196","article-title":"Management of febrile neutropenia: ESMO clinical practice guidelines","volume":"21","author":"de Naurois","year":"2010","journal-title":"Ann Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7399.1111","article-title":"\u03b2 lactam monotherapy versus \u03b2 lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis","volume":"326","author":"Paul","year":"2003","journal-title":"BMJ"},{"key":"B7","article-title":"Overcoming resistance: antibiotic guidance for multidrug-resistant febrile neutropenia in patients with cancer","volume":"7","author":"Kedzior","year":"2021"},{"key":"B8","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/imj.70237","article-title":"Introduction to the 2024 consensus guidelines for the management of neutropenic fever in patients with cancer: principles & practice of neutropenic fever","volume":"55","author":"Thursky","year":"2025","journal-title":"Internal Med J"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1177\/20499361251375354","article-title":"Prevalence, molecular carbapenemase detection, and antibiotic resistance of carbapenem-resistant Enterobacterales in a tertiary care hospital in East Jerusalem (2019\u20132023): a retrospective study","volume":"12","author":"AbuHadba","year":"2025","journal-title":"Ther Adv Infect Dis"},{"key":"B10","article-title":"Febrile neutropenia","author":"Punnapuzha","year":"2019"},{"key":"B11","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1200\/jop.18.00269","article-title":"Optimal management of neutropenic fever in patients with cancer","volume":"15","author":"Zimmer","year":"2019","journal-title":"J Oncol Pract"},{"key":"B12","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s12879-023-08058-6","article-title":"Epidemiology and source of infection in cancer patients with febrile neutropenia: an experience from a developing country","volume":"23","author":"Joudeh","year":"2023","journal-title":"BMC Infect Dis"},{"key":"B13","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1111\/imj.70248","article-title":"Consensus guidelines for initial management of neutropenic fever","volume":"55","author":"Douglas","year":"2025","journal-title":"Internal Med J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"196","DOI":"10.14740\/wjon850w","article-title":"Bacterial spectrum, isolation sites and susceptibility patterns of pathogens in adult febrile neutropenic cancer patients at a specialist hospital in Saudi Arabia","volume":"5","author":"Sirkhazi","year":"2014","journal-title":"World J Oncol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1111\/bcp.12310","article-title":"The prevention and management of infections due to multidrug resistant organisms in haematology patients","volume":"79","author":"Trubiano","year":"2015","journal-title":"Br J Clin Pharmacol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12941-025-00794-8","article-title":"Is neutropenia still the main risk factor for invasive aspergillosis? A contemporary university hospital retrospective cohort of invasive aspergillosis in neutropenic and non-neutropenic patients","volume":"24","author":"Guti\u00e9rrez-Villanueva","year":"2025","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.12520","article-title":"Evaluation of risk factors for mortality in febrile neutropenia","volume":"14","author":"Ceken","year":"2020","journal-title":"J Infection Developing Countries"},{"key":"B18","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1111\/imj.70249","article-title":"Consensus guidelines for the subsequent management of neutropenic fever after empiric therapy","volume":"55","author":"Douglas","year":"2025","journal-title":"Internal Med J"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1876292\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:45:00Z","timestamp":1785300300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1876292\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":18,"alternative-id":["10.3389\/fonc.2026.1876292"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1876292","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"article-number":"1876292"}}