Empirical antimicrobial monotherapy in patients after high‐dose chemotherapy and autologous stem cell transplantation: a randomised, multicentre trial

Abstract

Empirical antimicrobial intervention in patients with infectious complications after high-dose chemotherapy and autologous haematopoietic stem cell transplantation (ASCT) has not been studied extensively and has been selected in many of these patients according to recommendations for high-risk patients with haematological malignancies or patients under- SummaryWe report on 232 patients undergoing autologous haematopoietic stem cell transplantation (ASCT) entered into a multicentre, randomised trial comparing the efficacy and tolerability of meropenem (MPM) with that of piperacillin/tazobactam (P/T) as empirical antimicrobial first-line therapy for febrile neutropenia. In 27AE6% of patients in the MPM group and 22AE4% in the P/T group, therapy was initially supplemented with a glycopeptide for venous catheter infection or bacteraemia because of coagulase-negative staphylococci. Complete response rate after 72 h was 63AE8% in the MPM group and 49AE6% in the P/T group (P ¼ 0AE034). Overall complete response rate after treatment modification was 94AE0% in the MPM group and 93AE1% in the P/T group. Median time to defervescence was 2 d in the MPM group and 3 d in the P/T group. The most frequently isolated pathogens were Grampositive cocci. Treatment was well tolerated in both groups. One patient (0AE4%) died from infection. Empirical first-line therapy with MPM as well as with P/T is safe and effective in febrile episodes emerging after ASCT. Higher response rates to primary treatment can be achieved with MPM.

Piperacillin/tazobactam vs ceftazidime in the treatment of neutropenic fever in patients with acute leukemia or following autologous peripheral blood stem cell transplantation: a prospective randomized trial

“…When the glycopeptide antibiotic was added to the regimen of patients who were still febrile after 72 h, a further 14 patients of group I and 21 patients of group II became afebrile. Thus, the results are comparable to other data from the literature 17,18 and to our own data in previously published papers. 19,20 Antibiotic therapy was discontinued when the patients displayed a body temperature below 381C on 5 consecutive days, even if they were still neutropenic.…”

Antimicrobial therapy of febrile complications after high-dose chemotherapy and autologous hematopoietic stem cell transplantation—guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

“…In more than 60 % of patients during the phase of neutropenic fever after HDC and auto-HCT, the situation is FUO [13]. The initial antimicrobial therapy should cover the most frequent and threatening pathogens ( Table 3).…”

“…One third of cases of documented infection [13,14] are mostly caused by bacteria. Although a recent publication did not demonstrate an increased rate of infection in patients with severe oral mucositis [15], it is still widely believed that the major risk factors and sources of infection are the mucosal membranes of the oropharyngeal and gastrointestinal tract, which are frequently damaged by the conditioning therapies [6].…”

“…The incidence of febrile complications following HDC and auto-HSCT is 60-100 % [13,[16][17][18][19][20][21][22][23][24][25], whereas the majority is categorized as fever of unknown origin (FUO). One third of cases of documented infection [13,14] are mostly caused by bacteria.…”

Infektionen in der Hämatologie und Onkologie

“…Die Ergebnisse einer prospektiv randomisierten Studie zur antimikrobiellen Behandlung dieser Patientengruppe zeigen, dass eine initiale Monotherapie mit Piperacillin-Tazobactam (3-mal 4,5 g) oder mit Meropenem (3-mal 1 g) bei 50 bzw. 64% der Patienten zu einer dauerhaften Entfieberung führt [23]. Nach Supplementierung bzw.…”