BACKGROUND Bloodstream infections are serious complications in neutropenic cancer patients. There has been a universal pickup in multidrug resistant (MDR) strains. For individuals who are at high risk for infections caused by MDR bacteria, a novel de-escalation strategy has been developed. Determine the bacterial spectrum and antibiotic resistance pattern in febrile neutropenic cancer patients was the goal of this investigation. METHODS From 2019 to 2020, 60 cancer patients with febrile neutropenia who were sent to Isfahan's Omid Hospital were included in this retrospective analysis. Experiments were done on the antimicrobial susceptibility of isolated bacterial infections. RESULTS The patients' average age was 43.35±15.59 years. Ninety-one percent (55/61) of the 60 patients had hematologic malignancies, and 8.3 percent (5/61) had solid tumors. The majority of the germs were gram-negative bacteria (66.7 percent). E. coli was the pathogen that was isolated the most frequently (26.7%), followed by Klebsiella (16.7 percent). In addition, the most prevalent identified Gram-positive bacteria was Staphylococcus epidermidis (21.7 percent). Third-generation cephalosporin (ESBL-E) resistance was present in 50% of E. coli, along with 50% resistance to cotrimoxazole, ciprofloxacin, and piperacillin, 31% resistance to amikacin, and 20% resistance to meropenem (CRE). They had an 80% sensitivity to amikacin and a 70% sensitivity to ciprofloxacin. Ten percent of our patients had antibiotic resistance in the antibiogram (XDR). CONCLUSIONS In summary, most bacterial infections were resistant to different medications. The emergence and spread of Gram-negative bacteria that are resistant to antibiotics can be stopped by prudent antibiotic use.