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De-escalation of empiric broad spectrum antibiotics in hematopoietic stem cell transplant recipients with febrile neutropenia
- Source :
- Annals of Hematology
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Febrile neutropenia (FN) is a common serious complication in patients undergoing hematopoietic stem cell transplantation (HSCT) requiring urgent evaluation and initiation of empiric broad spectrum antibiotics (BSA). The appropriate duration of BSA for FN in patients with negative cultures and no identifiable infection remains undefined. We retrospectively analyzed allogenic and autologous HSCT patients with FN and negative infectious work-up at our facility from 2012 to 2018. The early de-escalation group (EDG) included those who had BSA de-escalation to fluoroquinolone prophylaxis at least 24 h prior to absolute neutrophil count (ANC) recovery after the patient was fever-free for at least 48 h. Among 297 patients undergoing their first HSCT who experienced FN with negative infectious work-up, 83 patients were de-escalated early with the remaining 214 in the standard of care group (SCG) whose BSA were continued until ANC was > 500. Duration of broad-spectrum antibiotics was shorter in EDG compared to SCG (3.86 days vs. 4.62 days, p = 0.03). Rates of mortality, new infections, and clinical decompensation requiring intensive care unit transfer and/or pressor use within 30 days were all similar between the two groups (0% vs. 0.4% p = 1.00, 0% vs. 1.4% p = 0.56, 13.2% vs. 8.4% p = 0.27). This indicates that it is safe to de-escalate antibiotics prior to ANC recovery, leading to less BSA exposure.
- Subjects :
- Male
medicine.medical_specialty
medicine.drug_class
medicine.medical_treatment
Febrile neutropenia
Antibiotics
Hematopoietic stem cell transplantation
Infections
Disease-Free Survival
law.invention
03 medical and health sciences
0302 clinical medicine
law
Internal medicine
medicine
Humans
Decompensation
Autografts
Retrospective Studies
business.industry
Hematopoietic Stem Cell Transplantation
Hematology
General Medicine
Middle Aged
Allografts
medicine.disease
Intensive care unit
De-escalation
Anti-Bacterial Agents
Survival Rate
030220 oncology & carcinogenesis
Absolute neutrophil count
Female
Original Article
Complication
business
Broad spectrum antibiotic
030215 immunology
Subjects
Details
- ISSN :
- 14320584 and 09395555
- Volume :
- 99
- Database :
- OpenAIRE
- Journal :
- Annals of Hematology
- Accession number :
- edsair.doi.dedup.....dd5b04c8eae82aa058ad760a03689a79