Safety and risk of febrile recurrence after early antibiotic discontinuation in high-risk neutropenic patients with haematological malignancies: a multicentre observational study

Autor:	Raphael Paret, Amandine Le Bourgeois, Gaëlle Guillerm, Benoit Tessoulin, Schéhérazade Rezig, Thomas Gastinne, Marie Anne Couturier, David Boutoille, Raphael Lecomte, Florence Ader, Steven Le Gouill, Séverine Ansart, Jean Philippe Talarmin, Benjamin Gaborit
Rok vydání:	2022
Předmět:	Pharmacology Microbiology (medical) Leukemia Myeloid Acute Neutropenia Infectious Diseases Hematologic Neoplasms Neoplasms Humans Bacteremia Pharmacology (medical) Prospective Studies Fever of Unknown Origin Anti-Bacterial Agents
Zdroj:	Journal of Antimicrobial Chemotherapy. 77:2546-2556
ISSN:	1460-2091 0305-7453
DOI:	10.1093/jac/dkac190
Popis:	Background Early antibiotic discontinuation according to the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations is not systematically applied in high-risk neutropenic patients with haematological malignancies. Methods A retrospective multicentre observational study was conducted over 2 years to evaluate the safety of early antibiotic discontinuation for fever of unknown origin (FUO) during neutropenia after induction chemotherapy or HSCT, in comparison with a historical cohort. We used Cox proportional hazards models, censored on neutropenia resolution, to analyse factors associated with febrile recurrence. Results Among 147 included patients in the ECIL-4 cohort, mainly diagnosed with acute leukaemia (n = 104, 71%), antibiotics were discontinued during 170 post-chemotherapy neutropenic episodes. In comparison with the historical cohort of 178 episodes of neutropenia without antibiotic discontinuation, no significant differences were observed regarding febrile recurrences [71.2% (121/170) versus 71.3% (127/178), P = 0.97], admission in ICUs [6.5% (11/170) versus 11.2% (20/178), P = 0.17], septic shock [0.6% (1/170) versus 3.9% (7/178), P = 0.07] and 30 day mortality [1.4% (2/147) versus 2.7% (4/150), P = 0.084]. In the ECIL-4 cohort, the rate of bacteraemia in case of febrile recurrence was higher [27.1% (46/170) versus 11.8% (21/178), P Conclusions After an FUO episode in high-risk neutropenia, compliance with ECIL-4 recommendations for early antibiotic discontinuation appears to be safe and mucosal damage was associated with febrile recurrence and bacteraemia. Prospective interventional studies are warranted to assess this strategy in high-risk neutropenic patients.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::90b187fd9e517b28fac6c760b55f71c6 https://doi.org/10.1093/jac/dkac190 Zobrazit plný text záznamu