Discontinuation of antimicrobial therapy in adult neutropenic haematology patients: A prospective cohort

Wyngaert, Zoé Van de; Berthon, Céline; Debarri, Houria; Bories, Claire; Bonnet, Sarah; Nudel, Morgane; Carpentier, Benjamin; Legrand, Charline; Barbieux, Sarah; Chauvet, Paul; Simonnet, Arthur; Willaume, Alexandre; Bossard, Jean‐Baptiste; Renaud, Loïc; Wattebled, Kevin James; Escure, Guillaume; Branche, Nicolas; Arib, Ines; Titécat, Marie; Quesnel, Bruno; Alfandari, S.

doi:10.1016/j.ijantimicag.2019.02.020

Cited by 19 publications

(21 citation statements)

References 32 publications

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“…In patients with PBI, use of intravenous antibiotics would be stopped with the remission of symptoms, radiological manifestations, laboratory findings, etc., or optimized and prolonged with non-remission or aggravation. Early discontinuation of intravenous antibiotics was defined as 5-8 days use of intravenous antibiotics [31][32][33][34], and an over 8-day intravenous regimen can be viewed as prolonged antibiotic therapy.…”

Section: Methodsmentioning

confidence: 99%

Community-Acquired Pneumonia and Hospital-Acquired Pneumonia in Adult Patients with Idiopathic Inflammatory Myopathy: Outcome and Antibiotic Therapy

Liang

Sun

et al. 2020

Rheumatol Ther

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Introduction Community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) are common complications in idiopathic inflammatory myopathy (IIM) patients, and are frequently associated with unfavorable outcome as well as prolonged antibiotic therapy. In this study, we intended to clarify whether clinical pulmonary infection score (CPIS) and multiple serum biomarkers are valuable in predicting unfavorable outcomes and prolonged antibiotic therapy in adult IIM patients complicated with CAP or HAP. Methods Data of IIM patients with CAP or HAP who were admitted to three tertiary centers from December 2010 to November 2019 were retrospectively collected. Cox proportional hazards regression analysis and logistic regression analysis were adopted to identify risk factors for unfavorable outcomes and prolonged antibiotic therapy in these patients. The predictive values of potential predictors were assessed using receiver operating characteristic analysis. Results The mortality rate was 60.6% in 109 IIM patients complicated with CAP or HAP. Myositis Disease Activity Assessment Visual Analogue Scales (MYOACT) score, CPIS and timely adjustment to antibiotics based on drug susceptibility test (DST-based antibiotic) were significantly associated with long-term outcome in these patients. With an optimal cutoff value of 6.5 and area under the curve (AUC) of 0.813, CPIS was a more satisfying predictor compared with MYOACT score. The peak C-reactive protein (CRP) level, DST-based antibiotics, and complication of interstitial lung disease (ILD) were also significantly correlated with prolonged antibiotic therapy. Conclusions IIM patients complicated with CAP or HAP frequently suffer from unfavorable outcomes. Compared with IIM disease activity, CPIS worked as a better predictor of outcome in these patients. Also, the peak CRP level during hospitalization might be valuable in predicting prolonged antibiotic therapy. The existence of ILD might impede early discontinuation of antibiotics. Timely adjustment to antibiotics based on drug susceptibility testing would decrease the mortality rate and reduce the incidence of prolonged antibiotic therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00268-7.

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Section: Methodsmentioning

confidence: 99%

Community-Acquired Pneumonia and Hospital-Acquired Pneumonia in Adult Patients with Idiopathic Inflammatory Myopathy: Outcome and Antibiotic Therapy

Liang

Sun

et al. 2020

Rheumatol Ther

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“…Recently, Van de Wyngaert et al 39 evaluated a stewardship strategy of discontinuation of antibiotics in AML patients with FN who received at least 7 days of IV antibiotics and met certain clinical criteria, regardless of ANC (Table 3). Fever recurred in only 20% of patients (10/49 cases), and duration of antibiotics was reduced significantly in the intervention group (287 days spared, decrease of 49%).…”

Section: De-escalation and Discontinuationmentioning

confidence: 99%

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

et al. 2019

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Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Sources: A literature search of PubMed was performed from inception to October 31, 2019. The general search terms used were oncology, cancer, hematologic malignancy, antimicrobial stewardship, antibiotic stewardship, febrile neutropenia, neutropenic fever, de-escalation, discontinuation, prophylaxis, practice guidelines, clinical pathway, rapid diagnostics, Filmarray, Verigene, MALDI-TOF, antibiotic allergy, and antimicrobial resistance. Study Selection and Data Extraction: Relevant English-language studies describing interventions supported by the Infectious Diseases Society of America guidelines on “Implementing an Antibiotic Stewardship Program” were included. Data Synthesis: Antibiotic stewardship publications in the oncology population have increased in recent years. Studies have described the impact of stewardship interventions, including preauthorization, prospective audit and feedback, implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN) prior to neutrophil recovery, allergy assessments, and use of rapid diagnostic testing. Many of these interventions have been shown to decrease antibiotic use without increased negative consequences, such as affecting length of stay or mortality. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence for implementing antibiotic stewardship interventions, particularly de-escalation of antibiotics for FN and implementation of clinical pathways for FN and sepsis, in oncology patients and HCT recipients. Summary tables highlight studies and specific research needs for clinicians. Conclusions: Immunocompromised populations, including oncology patients, have often been excluded from stewardship studies. Antibiotic stewardship is effective in reducing antibiotic consumption and improving outcomes in this patient population, although more quality data are needed.

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“…The proper timing of antibiotic administration is very important in the treatment of P. aeruginosa infection. The results of microorganism tests such as culturing and qPCR and patients' clinical conditions do not necessarily coincide [18][19][20]. In our experimental system using P. aeruginosa-infected cells, the counts of P. aeruginosa by qRT-PCR correlated well with the in ammatory response (IL-8 gene expression and production level) of infected cells compared to culturing and qPCR.…”

Section: Discussionmentioning

confidence: 80%

“…Culture-negative sepsis is commonly observed in ICU patients: previous studies have shown negative blood cultures in 30% of septic shock patient [18]. It has also been reported that blood cultures from febrile neutropenic patients can identify the pathogens in only 17 to 42% of cases [19,20]. Thus, to overcome the problems associated with bacterial culture, we adopted Yakult Intestinal Flora-SCAN (YIF-SCAN®), a highly sensitive and rapid system based on quantitative reverse transcription PCR (qRT-PCR) [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Rapid and Sensitive Quantification of Pseudomonas aeruginosa by Quantitative Reverse Transcription PCR Targeting of rRNA Molecules

Niikura

Atobe

Takahashi

et al. 2020

Preprint

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Background: For Pseudomonas aeruginosa, nosocomial infection control and appropriate antimicrobial treatment have become important issues. Diagnosis is critical in managing P. aeruginosa infection, but conventional methods are not highly accurate or rapid. A novel P. aeruginosa quantification system based on 23S rRNA-targeted quantitative reverse transcription PCR (qRT-PCR) is a candidate diagnostic tool for managing P. aeruginosa infection. Here, we assessed the performance and potential impact of qRT-PCR on antibiotic therapy administered to ICU patients.Methods: We first evaluated specificity and detection sensitivity of the 23S rRNA-targeted qRT-PCR system in vitro and determined whether P. aeruginosa viable counts detected by this system reflect the inflammatory response of infected cells. Next, we utilized this system on fecal samples collected from 65 septic ICU patients and 44 healthy volunteers to identify the ICU infection status. Additionally, we monitored drug-resistant P. aeruginosa in 4 ICU patients. The trend was compared with trends in fecal microbiota composition, antibiotic use, and mechanical ventilator use.Results: The 23S rRNA-targeted qRT-PCR system quantified P. aeruginosa directly from clinical samples with high sensitivity (blood, 1 cell/mL; stool, 100 cells/g) without cross-reaction (within 6 h). Additionally, P. aeruginosa numbers detected under antibacterial treatment correlated well with the inflammatory response compared to other detection methods such as culturing and qPCR. Using this system, we confirmed that the P. aeruginosa detection ratio in ICU patients was significantly higher than that in healthy volunteers (49.2% vs. 13.6%, P<0.05). While some ICU patients had high P. aeruginosa numbers in feces (108 cells/g of feces), some patients had very low P. aeruginosa numbers (102 cells/g of feces) as observed in healthy volunteers. P. aeruginosa counts in feces of ICU patients monitored by this system correlated negatively with the proportion of total obligate anaerobes and positively with facultative anaerobes and aerobes. Additionally, trends in P. aeruginosa counts accurately reflected various treatment backgrounds of ICU patients.Conclusion: Our results suggest that this new 23S rRNA-targeted qRT-PCR system is beneficial for early diagnosis and evaluation of appropriate antibacterial treatment and may be a useful tool in combating P. aeruginosa infection.

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Discontinuation of antimicrobial therapy in adult neutropenic haematology patients: A prospective cohort

Cited by 19 publications

References 32 publications

Community-Acquired Pneumonia and Hospital-Acquired Pneumonia in Adult Patients with Idiopathic Inflammatory Myopathy: Outcome and Antibiotic Therapy

Community-Acquired Pneumonia and Hospital-Acquired Pneumonia in Adult Patients with Idiopathic Inflammatory Myopathy: Outcome and Antibiotic Therapy

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

Clinical Significance of Rapid and Sensitive Quantification of Pseudomonas aeruginosa by Quantitative Reverse Transcription PCR Targeting of rRNA Molecules

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