Antimicrobial stewardship is of major importance in patients with febrile neutropenia (FN). In this study, we aimed to investigate the trends in resistance and the relationship with mortality rates in patients with FN. The single-center surveillance data of inpatients with FN and diagnosed as microbiologically confirmed bloodstream infections (BSIs) between 2006 and 2016 were reviewed retrospectively. A total of 950 episodes in 552 patients with BSIs were analyzed. Of whom, 55.9% were male, the median age was 43 years, and 35.6% had acute myeloid leukemia. In total, 1016 microorganisms were isolated from blood cultures. Gram-negatives accounted for 42.4% (n = 403) of the episodes. Among Gram-negatives, Enterobacteriaceae accounted for 346 (86%) (E. coli, n = 197; 34% extended-spectrum β-lactamases (ESBL) producers, and Klebsiella spp., n = 120; 48.3% ESBL producers). Also, 24 (20.0%) of Klebsiella spp. had carbapenemase activity. There were 6 (5.0%) colistin-resistant Klebsiella spp. Thirteen (26.5%) of Pseudomonas spp. and 17 (60.7%) of Acinetobacter spp. had carbapenemase activity. There were 2 (5.6%) colistin-resistant Acinetobacter spp. The 30-day mortality rates were 12.0%, 21.5%, 34.6%, and 29.0% in BSIs due to Gram-positive, Gram-negative bacterial, fungal, and polymicrobial etiology respectively (p = 0.001). BSIs with ESBL-producing (p = 0.001) isolates, carbapenem (p < 0.001), and colistin-resistant isolates (p < 0.001) were associated with increased mortality risk. The tremendous rise in resistance rates among Gram-negatives is dreadfully related to increasing mortality and leads to sharp shifts toward extreme restrictions of unnecessary antibiotic uses. Antimicrobial stewardship in patients with FN requires vigilance and tailoring of treatment upon local surveillance data.

抗生素管理在发热性中性粒细胞减少症（FN）患者中至关重要。在这项研究中，我们旨在调查FN患者的耐药趋势以及与死亡率的关系。回顾性分析了2006年至2016年间FN住院并被诊断为微生物学确诊的血液感染（BSI）的单中心监测数据。分析了552例BSI患者中总共950次发作。其中，男性占55.9％，中位年龄为43岁，急性髓性白血病占35.6％。总共从血液培养物中分离出1016种微生物。革兰氏阴性菌占 发作的42.4％（n = 403）。在革兰氏阴性菌中，肠杆菌科占346（86％）（大肠杆菌，n  = 197；34％的广谱β-内酰胺酶（ESBL）生产商和克雷伯菌属。，n  = 120; 48.3％的ESBL生产商）。此外，还有24（20.0％）克雷伯菌属。具有碳青霉烯酶活性。耐大肠菌素的克雷伯菌属有6个（5.0％）。假单胞菌属十三种（26.5％）。和17（60.7％）不动杆菌属。具有碳青霉烯酶活性。有2（5.6％）大肠菌素耐药性不动杆菌属。由于革兰氏阳性，革兰氏阴性细菌，真菌和多微生物病因，BSI的30天死亡率分别为12.0％，21.5％，34.6％和29.0％（p  = 0.001）。产生ESBL的BSI（p = 0.001）分离株，碳青霉烯（p  <0.001）和对大肠粘菌素耐药的分离株（p  <0.001）与增加的死亡风险相关。革兰氏阴性菌耐药率的急剧上升与死亡率增加密切相关，并导致朝着极端限制不必要抗生素使用的方向急剧转变。FN患者的抗菌管理需要​​保持警惕，并根据当地监测数据调整治疗方案。