Bacterial Infections in Neutropenic Cancer Patients in Iraq: A Cross-Sectional Study of Clinical and Microbiological Patterns

• Sura Ali Majeed

  Al-Farahidi University

• Ahmed Mubarak

  Ishtar Medical Institute , Baghdad, Iraq

• Samar Almehdi

  Iraqi Cancer Board, Ministry of Health, Baghdad, Iraq. , Oncology Teaching Hospital, Medical City, Baghdad, Iraq.

• Mohammed Kamil Al-Qayyim

  Hematology and Transplant Center (HTC center), Medical City Complex, Baghdad, Iraq.

• Musaab Kadhim Al-Abboodi

  Alamal National Hospital for Cancer Treatment, Baghdad, Iraq.

Neutropenia is a serious and frequent complication in cancer care, particularly following chemotherapy. It markedly increases the risk of infections and is often complicated by fever, which may be the only early clinical sign of life-threatening bacterial infections. Understanding local epidemiological trends is critical to guiding effective infection control and antibiotic strategies, especially in resource-limited settings. In Iraq, where local epidemiological data remain scarce, this study provides urgently needed insights to inform infection control in oncology care. This study aimed to evaluate the incidence of fever and patterns of bacterial infections among neutropenic cancer patients in Iraq. A prospective cross-sectional study was conducted on 98 adult neutropenic cancer patients admitted to the Oncology Teaching Hospital, Almal National Hospital for Cancer Treatment, and Hematology and Transplant Center (HTC). Data on age, gender, cancer type, neutropenia severity, fever presence, and microbiological culture results were extracted and analyzed descriptively. The majority of the patients were female (68.4%) and over 50 years of age (75.5%). Hematological malignancies accounted for 81% of all cases. The most prevalent form was moderate neutropenia (68.4%). Fever developed in 58.2% of patients, and among these, 77.2% had positive bacterial cultures. Gram-negative organisms were predominant, with Escherichia coli (33.3%) and Klebsiella pneumoniae (29.8%) being the most frequently isolated pathogens. Neutropenia is highly prevalent among Iraqi cancer patients with hematological malignancies and is frequently accompanied by fever and Gram-negative bacterial infections. These findings highlight the need for routine microbiological surveillance, timely diagnosis, and context-specific empirical antibiotic protocols. Strengthening infection prevention strategies and updating treatment guidelines in oncology centers are essential to reducing infection-related morbidity in this vulnerable population.

Abdulrahman Ahmed, H., Hasheem Mahmood, H., Hosam Aldin Sami, H., Natiq Taher, A., Garcia-Vello, P., Ali, E., Repetto, E., Williams, A., Gordillo Gomez, F., & Moussally, K. (2024). Extensively Antibiotic-Resistant Bacterial Infections in Trauma Cases Managed at the Médecins Sans Frontières Tertiary Orthopaedic Center in Mosul, Iraq: A Case Series. Open Forum Infectious Diseases, 11(8). https://doi.org/10.1093/ofid/ofae379

Al-Shawy, H. A., & Jumaa, A. K. (2025). Neutropenic fever in patients with Hematologic Malignancies: Microorganisms and antimicrobial susceptibility. Advancements in Life Sciences, 12(1), 275–281. https://doi.org/10.62940/als.v12i1.2475

Home or Hope? The Impossible Choice for Iraqi Cancer Patients - Shafaq News. (2025). https://shafaq.com/en/Report/Home-or-Hope-The-Impossible-Choice-for-Iraqi-Cancer-Patients

Iraq Makes Progress in Improving Cancer Services, Implements imPACT Review Recommendation. (2023). https://www.iaea.org/newscenter/news/iraq-makes-progress-in-improving-cancer-services-implements-impact-review-recommendation

Kedzior, S. K., Ham, Young. Y., & Bubalo, J. (2021). Overcoming Resistance: Antibiotic Guidance for Multidrug-Resistant Febrile Neutropenia in Patients with Cancer. In J Hematol Oncol Pharm. (Vol. 11, Number 2). https://www.jhoponline.com/issue-archive/2021-issues/april-2021-vol-10-no-2/overcoming-resistance-antibiotic-guidance-for-multidrug-resistant-febrile-neutropenia-in-patients-with-cancer

Lucas, A. J., Olin, J. L., & Coleman, M. D. (2018). Management and Preventive Measures for Febrile Neutropenia. P & T : A Peer-Reviewed Journal for Formulary Management, 43(4), 228–232.

Mjali, A., Al Baroodi, B. N. H., & Alharganee, A. (2021). A Pattern of Bacterial Infections in Acute Leukemia Patients with Neutropenic Fever in Middle Euphrates Region of Iraq. International Journal of Drug Delivery Technology, 11(2), 248–251.

Mohsin, K., Mula-Hussain, L., & Gilson, R. (2024). HealthCare Access Barrier (HCAB) framework for the barriers to cancer care during conflicts: perspective from Iraq. BMJ Oncology, 3(1), e000252. https://doi.org/10.1136/bmjonc-2023-000252

Mula-Hussain, L. (2012). Cancer Care in Iraq: A Descriptive Study. LAP LAMBERT Academic Publishing.

Neutropenia (low neutrophil count) - Mayo Clinic. (n.d.). Retrieved https://www.mayoclinic.org/symptoms/neutropenia/basics/definition/sym-20050854

Obaid, R. M., Yaseen, F. T., & Mukhlif, M. Y. (2020). Blood Cells Depletion after Chemotherapy in Iraqi Women with Breast Cancer. Indian Journal of Forensic Medicine & Toxicology, 14(4), 3379–3382. https://doi.org/10.37506/ijfmt.v14i4.12146

Park, H. M., Pom, B., Farina, K. A., & Rattu, M. A. (2023). Prevention and Treatment of Chemotherapy-Induced Febrile Neutropenia in Adults. US Pharm, 48(4). https://www.uspharmacist.com/article/prevention-and-treatment-of-chemotherapyinduced-febrile-neutropenia-in-adults

Rout, P., Reynolds, S. B., & Zito, P. M. (2025). Neutropenia.

Ruaa, S. H., Mohammed, S. S., & Abd Al-Hussan, G. F. (2023). Screening of Some Bacterial and Fungal Infections in Neutropenic Cancer Patients in Al-Najaf Governorate, Iraq. Iranian Journal of War and Public Health, 15(2), 115–121. https://doi.org/10.58209/ijwph.15.2.115

The Ministry of Health, in cooperation with UNICEF and WHO, releases the assessment results of WASH and infection prevention control services in health facilities in Iraq. (2022). UNICEF. https://www.unicef.org/iraq/press-releases/ministry-health-cooperation-unicef-and-who-releases-assessment-results-wash-and

WHO EMRO. (2023). WHO scales up implementation of infection prevention and control measures in Iraq. WHO. https://www.emro.who.int/iraq/news/who-scales-up-infection-prevention-and-control-measures-in-iraq.html

• HTML
• PDF

• Clinical Trials and Therapeutics

Copyright (c) 2026 Sura Ali Majeed, Ahmed Mubarak, Samar Almehdi, Mohammed Kamil Al-Qayyim, Musaab Kadhim Al-Abboodi

This work is licensed under a Creative Commons Attribution 4.0 International License.