Empiric antibiotic protocols for cancer patients with neutropenia: a single center study of treatment efficacy and mortality in patients with bacteremia.
Int J Antimicrob Agents. 2017 Jul 10;:
Authors: Kleinhendler E, Cohen MJ, Moses AE, Paltiel O, Strahilevitz J, Cahan A
Abstract
BACKGROUND: A number of empiric antibiotic treatment options for febrile neutropenia exist, yet there is no universally-accepted initial protocol. We aimed to assess the performance of a protocol (piperacillin, gentamicin and cefazolin) introduced over 40 years ago and compare its coverage against bacteria isolated from blood of neutropenic patients to that of various commonly used antibiotic treatment protocols.
METHODS: Adults with neutropenia admitted between 2003 and 2012 to the hemato-oncologic departments, in whom blood cultures were taken on admission were included. Appropriateness of several common antibiotic protocols was assessed based on the susceptibility of the blood isolates. Crude mortality rates were computed by the susceptibility of bacteria isolated from patients' blood to the actual treatment given.
RESULTS: In total, 180 admissions of neutropenic patients (in which fever above 38°C was documented in 95) with positive blood cultures were analyzed. The actual antibiotic regimen prescribed was deemed appropriate in 82% of bacteremia episodes. The recommended institutional protocol was used in 62% of bacteremia episodes in neutropenic patients. This protocol would have been appropriate in 85% of all neutropenic bacteremia episodes and 89% of episodes in febrile neutropenia patients, compared to piperacillin/tazobactam (79%, p=0.13 and 76%, p=0.002, respectively) and to imipenem (93%, p=0.004 and 92%, p=0.74, respectively). Isolation of bacteria resistant to the actual antibiotic treatment given was associated with higher mortality at one week and 30 days.
CONCLUSIONS: Common current antibiotic regimens provide similar coverage among febrile neutropenic patients whereas broad spectrum antibiotic combinations maximize coverage among neutropenic patients.
PMID: 28705670 [PubMed - as supplied by publisher]