Analysis of the value of empiric vancomycin administration in febrile neutropenia occurring after autologous peripheral blood stem cell transplants

Abstract

Summary:We conducted a retrospective review of 125 patients undergoing high-dose therapy and stem cell rescue in order to evaluate the incidence of documented infection and the utility of the administration of vancomycin empirically. All patients received prophylactic oral quinolone therapy. Because neutropenia in this setting is relatively brief, 21 patients never manifested fever, and no patient died of infection. Of the remaining 104 patients, positive blood cultures were obtained in only 10, nine with a gram stain positive and one with a gram stain negative organism. Sixty-two patients without any evidence of gram positive infection received vancomycin according to the existing algorithm for care of neutropenic fevers. In this population of patients, empiric administration of vancomycin for neutropenic fevers without culture documentation appears to be unnecessary, could be discontinued safely and at substantial cost savings, and might slow the appearance of vancomycinresistant organisms. Keywords: autologous stem cell transplant; vancomycin; neutropenic fever; infections Infection is a major cause of morbidity and mortality in cancer patients receiving chemotherapy, especially in those undergoing high-dose chemotherapy and bone marrow transplantation. Increased infections in an immunocompromized host are related to neutropenia caused by malignancy and chemotherapeutic agents, the duration of neutropenia, altered immune status, impaired phagocytic function, changes in microbial flora, and the presence of indwelling central venous catheters.1-5 The degree of neutropenia and its duration are the major factors that determine risk of infection. Approximately 60% of febrile episodes in neutropenic patients are associated with infection, and one third of these are bacteremias. Broad-spectrum antibiotics are given to patients with febrile neutropenia, but opinions on the appropriate empiric

Oral ciprofloxacin as antibacterial prophylaxis after allogeneic bone marrow transplantation: a reappraisal

“…ents receiving prophylactic fluoroquinolone seems not to be a serious problem even in the most recent reports, [14][15][16] we believe it will be encountered eventually and we report our experience here.…”

Utility of obtaining blood cultures in febrile neutropenic patients undergoing bone marrow transplantation

“…[26][27][28] All patients had blood cultures drawn from at least two separate ports of an indwelling vascular device at the onset of fever and neutropenia. For each culture drawn through an indwelling vascular device, 20 ml of blood was collected, while 10 ml of blood was collected when drawn from a peripheral vein.…”

Early Infectious Complications after High-Dose Therapy and Autologous Blood Stem Cell Transplantation

“…As reported by others [1,3,4,8,9], the early infectious complications after HDT and ASCT are usually not severe. We observed no infection-related death in this cohort of 100 patients treated with 133 HDT courses.…”

“…This did not affect the duration of fever. Like others [4] we prefer vancomycin for second-line treatment in neutropenic fever.…”

“…Only few data have been published regarding the frequency and type of infectious complications after high-dose therapy (HDT) and autologous blood stem cell transplantation (ASCT) (1,3,4). We evaluated therefore our first hundred patients to investigate infection-associated parameters and to identify predictive factors.…”