Discontinuation of antimicrobial therapy in adult neutropenic haematology patients: A prospective cohort
| Autor: | Loïc Renaud, Jean-Baptiste Bossard, Zoé Van de Wyngaert, Sarah Barbieux, Alexandre Willaume, Guillaume Escure, Claire Bories, Bruno Quesnel, Serge Alfandari, Marie Titecat, Morgane Nudel, Céline Berthon, Sarah Bonnet, Benjamin Carpentier, Houria Debarri, Paul Chauvet, Ines Arib, Nicolas Branche, Arthur Simonnet, Kevin James Wattebled, Charline Legrand |
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| Přispěvatelé: | Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Adult Male medicine.medical_specialty Neutropenia Adolescent medicine.drug_class Cefepime [SDV]Life Sciences [q-bio] 030106 microbiology Antibiotics Fever of Unknown Origin 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine Medicine Humans Pharmacology (medical) 030212 general & internal medicine Prospective Studies Fever of unknown origin Prospective cohort study Aged First episode Aged 80 and over business.industry General Medicine Middle Aged medicine.disease 3. Good health Discontinuation Anti-Bacterial Agents Leukemia Myeloid Acute Infectious Diseases Treatment Outcome Withholding Treatment Female business Febrile neutropenia medicine.drug |
| Zdroj: | International Journal of Antimicrobial Agents International Journal of Antimicrobial Agents, 2019, 53, pp.781-788. ⟨10.1016/j.ijantimicag.2019.02.020⟩ |
| ISSN: | 0924-8579 |
| DOI: | 10.1016/j.ijantimicag.2019.02.020⟩ |
| Popis: | Objectives Antibiotics for febrile neutropenia (FN) in acute myeloid leukaemia (AML) patients undergoing intensive chemotherapy are usually maintained until neutropenia resolution, because of the risk of uncontrolled sepsis in this vulnerable population. This leads to unnecessarily prolonged antimicrobial therapy. Methods Based on ECIL-4 recommendations, we modified our management strategy and discontinued antibiotics after a pre-established duration in patients treated for a first episode of FN between August 2014 and October 2017. Results Antibiotics were stopped during 62 FN episodes, and maintained in the control group (n = 13). Median age of patients was 54 years. A total of 39 (63%) patients received induction and 23 (37%) consolidation chemotherapy; 36 (58%) patients had fever of unknown origin. Median neutropenia length was 26 days (IQR 24–30). Antibiotics were started at day 9 (IQR 5–13). Most patients received piperacillin-tazobactam (56%) or cefepime (32%). Antimicrobial therapy was longer in the control group than in the policy compliant group, 10 (IQR 7–16) vs. 19 days (IQR 15–23), P = 0.0001. After antibiotics discontinuation, 20% patients experienced fever recurrence, within 5.5 days (IQR 3–7.5). None of these febrile episodes were severe and 80% patients remained afebrile, with neutrophil recovery occurring within 5 days (IQR 2–8.5). Overall, 287 antibiotics days were spared; this represents 49% of all days with antibiotics. No patient had died at day 30 from intervention; six died during late follow-up, two from graft-versus-host disease and four from relapsed or refractory leukaemia. Conclusions Discontinuing antibiotics in neutropenic AML patients treated for a first episode of FN is safe, and results in significant antibiotic sparing. |
| Databáze: | OpenAIRE |
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