Stopping antibiotic therapy after 72 h in patients with febrile neutropenia following intensive chemotherapy for AML/MDS (safe study): A retrospective comparative cohort study

EClinicalMedicine

R. Aerts¹  A. Vlak²  E. Storme³  I. Moors⁴  A. Dunbar⁵  B.J.A. Rijnders⁶  B. Sciot⁶  J.J. Cornelissen⁶  G. Papageorgiou⁶  A. Schauwvlieghe⁷  T. Van Der Wel⁸  J. Maertens⁸  T. Mercier⁸ 

[1] Corresponding author at: Department of hematology, Ghent University Hospital, Gent, Belgium.;Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands;Department of Hematology, Universitaire Ziekenhuizen Leuven, KU Leuven, Belgium;Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven 3000, Belgium;Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands;Department of Hematology, Universitaire Ziekenhuizen Leuven, KU Leuven, Belgium;Department of hematology, Ghent University Hospital, Gent, Belgium;Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands;

关键词: Febrile neutropenia;    Leukaemia;    Opportunistic infections;    Antimicrobial stewardship;    Multi-drug resistant bacteria;    Microbiome;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Induction chemotherapy for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) is almost universally complicated by febrile neutropenia(FN). Empirical broad-spectrum antibiotic therapy (EBAT) strategies advocated by guidelines result in long periods of broad-spectrum antibiotic therapy. We compared the outcome of AML/MDS patients treated with a 3-day versus a prolonged (until neutrophil recovery) regimen. Methods: This is a retrospective comparative cohort study in AML or MDS patients undergoing remission-induction chemotherapy from 2011 to 2019, comparing 2 tertiary care hospitals with different strategies regarding antibiotic treatment for FN. At Erasmus University medical center(EMC), EBAT was stopped after 3 days of FN, in absence of a clinically or microbiologically documented infection. In the University Hospitals Leuven(UZL), a prolonged strategy was used, where EBAT was given until neutrophil recovery. The primary endpoint was a serious medical complication(SMC) defined as death or ICU admission in the 30 days after the start of chemotherapy. Findings: 305 and 270 AML or MDS patients received chemotherapy at EMC and UZL, respectively. Broad-spectrum antibiotic treatment was given for a median of 19 days (IQR13-25) at UZL versus 9 days at EMC (IQR5–13) (p <0·001). With the 3-day EBAT strategy, an SMC was observed in 12·5% versus 8·9% with the prolonged strategy (p = 0·17). The hazard ratio for an SMC was not significantly higher with the 3-day strategy (HR 1·357,95%CI 0·765–2·409). Interpretation: This study suggests that during remission induction chemotherapy it is safe to stop antibiotics after 3 days of FN in absence of infection. A comparison of both strategies in a prospective trial should be pursued.

【 授权许可】

Unknown