Amikacin and ceftazidime as empirical antibiotic therapy in severely neutropenic patients: analysis of prognostic factors

Abstract

This study aimed to evaluate the efficacy of amikacine and ceftazidime as an empirical antibiotic therapy for neutropenic patients affected by haematological neoplasms and to investigate the presence of prognostic features suggesting a poor outcome with this antibiotic combination at the onset of infection. This could allow the identification of subgroups of patients with a low rate of response to amikacin/ceftazidime therapy; in these patients different initial empirical therapy may be indicated. The study population comprised 166 severely neutropenic (absolute neutrophil count below 500/microliters) oncohaematological patients with fever or clinical signs of infection. Multivariate analysis confirmed four negative prognostic factors: 3 or more days of hospitalization at the onset of an infectious episode, a diagnosis of acute myelmany factors are present, cases can be stratified into three groups, of significantly different prognosis: favourable (0 or 1 factor) 76% success; intermediate (2 factors) 52% success; unfavourable (3 or 4 factors) 19% success. At the onset of an infectious episode a subgroup of patients with a very low response rate to empirical amikacin/ceftazidime antibiotic therapy is identifiable, for whom a different therapy is indicated. Because of the high rate of proven or probable fungal infections in this group, the immediate administration of a systemic antifungal therapy, in addition to antibacterial agents, could be considered in these high-risk patients. Studies should be specifically addressed to evaluating a stratification of empirical antibiotic therapy according to risk factors present at the onset of infection.

Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients

“…The derivation and validation of both models involved heterogeneous samples, with solid tumours, acute leukaemia and bone marrow transplantation (BMT), which differ in their baseline characteristics. Therefore, FN is managed differently in each particular scenario (Rossini et al , 1994; Nakagawa et al , 2009). …”

Risk assessment of patients with hematologic malignancies who develop fever accompanied by pulmonary infiltrates

“…Febrile neutropenia after chemotherapy for hematologic malignancies remains a frequent and potentially life‐threatening complication, although the mortality rate associated with this complication has decreased to less than 10% over the last 3 decades 1. Nonetheless, several studies have demonstrated that patients with neutropenia are a heterogeneous group exhibiting variability in terms of risk of infection‐related morbidity and mortality 2–8. At present, low‐risk patients with febrile neutropenia are safely managed with oral antibiotics9, 10 or with early discharge from hospital on the basis of suitable risk models 6, 8, 11…”

Oral versus Intravenous Empirical Antimicrobial Therapy for Fever in Patients with Granulocytopenia Who Are Receiving Cancer Chemotherapy

“…1,2 A number of prognostic factors have been identified, the most important of which C are the type and stage of the underlying disease and the aggressiveness of cytotoxic chemotherapy. [3][4][5][6][7][8][9][10][11] Both factors have a strong influence on the duration and severity of granulocytopenia. As compared with patients who have granulocytopenia for an extended time, those in whom the duration of granulocytopenia is short may be at lower risk for infectious complications, are more likely to have a response to empirical antimicrobial therapy, and may require a different approach to the management of fever.…”