Early discontinuation of empirical antibacterial therapy in febrile neutropenia: the ANTIBIOSTOP study

Clech, Lénaïg Le; Talarmin, Jean–Philippe; Couturier, Marie‐Anne; Ianotto, Jean‐Christophe; Nicol, C.; Calloch, Ronan Le; Santos, Stéphanie Dos; Hutin, P.; Tandé, Didier; Cogulet, Virginie; Berthou, Christian; Guillerm, Gaëlle

doi:10.1080/23744235.2018.1438649

Cited by 62 publications

(75 citation statements)

References 25 publications

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“…Shortening the course of EAT in haematological patients with febrile neutropenia remains a subject of debate (13,14) while there is increasing evidence supporting a shorter course of EAT in these highrisk haematology patients (8)(9)(10). Many of these studies focus on the safety of the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendation to discontinue EAT after 48 hours of apyrexia (3,8,9,15). This policy reduces EAT in comparison to previous recommendations (8,9,15).…”

Section: Discussionmentioning

confidence: 99%

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Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome

Niessen

Mourik

Bruns

et al. 2020

Preprint

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Introduction: Current guidelines advocate empirical antibiotic treatment (EAT) in haematological patients with febrile neutropenia. However, the optimal duration of EAT is unknown. In 2011, we have introduced a protocol, promoting discontinuation of carbapenems as EAT after three days in most patients and discouraging the standard use of vancomycin. This study assesses the effect of introducing this protocol on carbapenem and vancomycin use in high-risk haematological patients and its safety. Methods: A retrospective before-after study was performed comparing a cohort from 2007 to 2011 (period I, before restrictive EAT use) with a cohort from 2011-2014 (period II, restrictive EAT use). Neutropenic episodes related to chemotherapy or stem cell transplantation (SCT) in patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS) were analysed. The primary outcome was the use of carbapenems and vancomycin as EAT during neutropenia, expressed as days of therapy (DOT)/100 neutropenic days and analysed with interrupted time series (ITS). Also the use of other antibiotics was analysed. Safety measurements included 30-day mortality, ICU admittance within 30 days after start of EAT and positive blood cultures with carbapenem-susceptible microorganisms. Results : 362 neutropenic episodes with a median duration of 18 days were analysed, involving 201 patients. ITS analysis showed decreased carbapenem use with a step change of -16.1 DOT/100 neutropenic days (95% CI -26.77 to -1.39) and an overall reduction of 21.6% (8.7 DOT/100 neutropenic days). Vancomycin use decreased with a step change of -13.7 DOT/100 neutropenic days (95% CI -23.75 to -3.0) and an overall reduction of 54.7% (14.6 DOT/100 neutropenic days). The use of all antibiotics combined decreased from 155.6 to 138 DOT/100 neutropenic days, a reduction of 11.3%. No deaths directly related to early discontinuation of EAT were identified, also no notable difference in ICU-admission (9/116 in period I, 9/152 in period II) and positive blood cultures (4/116 in period I, 2/152 in period II) was detected. Conclusion : The introduction of a protocol promoting restrictive use of EAT resulted in reduction of carbapenem and vancomycin use and appears to be safe in AML or high-risk MDS patients with febrile neutropenia during chemotherapy or SCT.

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Section: Discussionmentioning

confidence: 99%

“…Many of these studies focus on the safety of the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendation to discontinue EAT after 48 hours of apyrexia (3,8,9,15). This policy reduces EAT in comparison to previous recommendations (8,9,15).…”

Section: Discussionmentioning

confidence: 99%

Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome

Niessen

Mourik

Bruns

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Shortening the course of EAT in haematological patients with febrile neutropenia remains a subject of debate (11) while there is increasing evidence supporting a shorter course of EAT in these high risk haematology patients (7-9,12). Many of these studies focus on the safety of the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendation to discontinue EAT after 48 hours of apyrexia (3,7,8,13). This policy reduces EAT in comparison to previous recommendations (7,8,13).…”

Section: Discussionmentioning

confidence: 99%

“…Many of these studies focus on the safety of the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendation to discontinue EAT after 48 hours of apyrexia (3,7,8,13). This policy reduces EAT in comparison to previous recommendations (7,8,13).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome

Niessen

Mourik

Bruns

et al. 2019

Preprint

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Introduction: Current guidelines advocate empirical antibiotic treatment (EAT) in haematological patients with febrile neutropenia. However, the optimal duration of EAT is unknown. In 2011, we have implemented a protocol advocating more restrictive use of EAT in patients with febrile neutropenia. This study assesses the effect of this protocol on carbapenem use in high risk haematological patients and its safety. Methods: A retrospective before-after study was performed comparing a cohort from 2007 to 2011 (period I, before restrictive EAT use) with a cohort from 2011-2014 (period II, restrictive EAT use). Neutropenic episodes related to chemotherapy or stem cell transplantation (SCT) in patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS) were analysed. The primary outcome was the use of carbapenems as EAT during neutropenia, expressed as days on therapy (DOT). Also the use of other antibiotics was analysed. Safety measurements included 30-day mortality, ICU admittance within 30 days after start of EAT and blood cultures positive for microorganisms sensitive to a carbapenem. Results: 362 neutropenic episodes with a median duration of 18 days were analysed, involving 201 patients. DOT with carbapenems decreased from a median of eight days (period I) to a median of six days (period II), a reduction of 25%. Additionally, vancomycin use decreased with 55%. No deaths were directly related to early discontinuation of EAT, also no notable difference in ICU-admission and positive blood cultures was detected. Conclusion: Implementation of a protocol promoting restrictive use of EAT resulted in reduction of carbapemen use and appears to be safe in AML or high-risk MDS patients with febrile neutropenia during chemotherapy or SCT.

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Infections in Patients with Cancer

Torres¹,

Kontoyiannis²,

Rolston³

2022

Holland‐Frei Cancer Medicine

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Overview Patients with cancer have increased risk of developing infections, owing both to their underlying disease and its treatment. This risk appears to be greatest in patients with hematologic malignancies and in hematopoietic cell transplant (HCT) recipients. This is due primarily to the development of various immunologic defects such as neutropenia and impaired cellular and/or humoral immunity, each associated with a unique spectrum of infection. Newer therapeutic modalities for the treatment of some cancers are changing the spectrum of infections as are the increasing use of catheters and other medical devices. While bacterial infections are documented most often, opportunistic fungal and viral infections are being encountered with increasing frequency. The morbidity and mortality of infection in cancer patients are generally greater than in the general population. Thus, early diagnosis and the prompt administration of appropriate therapy are of paramount importance. Antimicrobial resistance among these pathogens has become a worldwide problem, which can only be partially tackled by the development of novel agents. Consequently, the importance of conducting frequent epidemiologic surveillance in order to detect local epidemiologic shifts and of infection prevention, infection control, and antimicrobial stewardship cannot be emphasized enough. The number of cancer survivors is steadily increasing. Many of these patients remain immunosuppressed for substantial periods of time. Keeping these survivors healthy and infection free will continue to be a challenge for years to come.

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Early discontinuation of empirical antibacterial therapy in febrile neutropenia: the ANTIBIOSTOP study

Abstract: These results suggest that early discontinuation of empirical antibiotics in FUO is safe for afebrile neutropenic patients.

Cited by 62 publications

References 25 publications

Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome

Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome

Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome

Infections in Patients with Cancer

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