Non-nephrotoxic empiric antimicrobial therapy in febrile neutropenic cancer patients

Twenty-four cancer patients with diffuse interstitial pneumonitis (DIP) were randomized to undergo an open lung biopsy (OLB) within 8 hours of presentation (12 patients) or to receive empiric antimicrobial therapy (ET) with trimethoprim-sulfamethoxazole (TMP-SMX) erythromycin for a minimum of 4 days (12 patients). Patients whose condition deteriorated underwent an OLB on day 4. Eight of 12 patients (67%) having OLB survived versus 10 of 12 (83%) receiving ET (P = .64). Morbidity occurred in nine of 12 (75%) having OLB versus eight of 12 (67%) receiving ET (P = 1.0). Concurrently, there were 14 additional cancer patients with DIP who were not randomized (nine refused, three had a coagulopathy contraindicating surgery, two were excluded by primary care physicians) and who were comparable demographically to the randomized group. Two received OLB and 12 ET. Combining the randomized and nonrandomized groups, eight of 14 (57%) having an initial OLB survived versus 18 of 24 (75%) of ET-treated patients (P2 = .19). Results of the OLB were seven Pneumocystis carinii pneumonia (PCP), five nonspecific pneumonitis (NSP), one cytomegalovirus, and one lymphoma. Results of OLB led to discontinuation of antibiotics in three patients. Of the 24 ET patients, eight failed to improve by day 4 and had an OLB. Results were two NSP, two PCP, two cancer, one blastomycosis, and one Candida pneumonia. Complications were seen in 10 of 14 (72%) initial OLB patients versus 14 of 24 (58%) patients on the ET arm (P = .65). When the complication rate between patients receiving only empiric antibiotics was compared with all patients having an OLB (initially or on day 4), the difference was greater in patients undergoing OLB (37% v 72%, respectively) (P2 = .14). ET with TMP-SMX plus erythromycin and broad spectrum antibiotics in granulocytopenic patients appeared to be as successful and potentially less toxic than an OLB in this study. Although the number of patients in this study was small, these data suggest that a trial of empiric antibiotic management may be reasonable in cancer patients presenting with DIP, especially if they are nonneutropenic.

Download Full-text

Empiric Antimicrobial Therapy for Febrile Granulocytopenic Cancer Patients: Lessons from four EORTC trials

Acta Oncologica ◽

10.3109/02841868809093577 ◽

1988 ◽

Vol 27 (5) ◽

pp. 497-502 ◽

Cited By ~ 7

Author(s):

J. Klastersky

Keyword(s):

Cancer Patients ◽

Antimicrobial Therapy ◽

Empiric Antimicrobial Therapy

Download Full-text

Empiric antimicrobial therapy for early-onset pneumonia in severe trauma patients

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01870-2 ◽

2022 ◽

Author(s):

Maël Gennequin ◽

Delphine Bachelet ◽

Philippine Eloy ◽

Jean-Denis Moyer ◽

Antoine Roquilly ◽

...

Keyword(s):

Antimicrobial Therapy ◽

Early Onset ◽

Severe Trauma ◽

Trauma Patients ◽

Empiric Antimicrobial Therapy

Download Full-text

Appropriateness of empiric antimicrobial therapy with imipenem/colistin in severe septic patients: observational cohort study

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-018-0292-7 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Ahlem Trifi ◽

Sami Abdellatif ◽

Cyrine Abdennebi ◽

Foued Daly ◽

Rochdi Nasri ◽

...

Keyword(s):

Cohort Study ◽

Antimicrobial Therapy ◽

Observational Cohort Study ◽

Empiric Antimicrobial Therapy ◽

Observational Cohort

Download Full-text

Impact of Inactive Empiric Antimicrobial Therapy on Inpatient Mortality and Length of Stay

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00466-06 ◽

2006 ◽

Vol 50 (10) ◽

pp. 3355-3360 ◽

Cited By ~ 27

Author(s):

Kimberly K. Scarsi ◽

Joe M. Feinglass ◽

Marc H. Scheetz ◽

Michael J. Postelnick ◽

Maureen K. Bolon ◽

...

Keyword(s):

Length Of Stay ◽

Antimicrobial Therapy ◽

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Empiric Therapy ◽

Inpatient Mortality ◽

In Vitro Susceptibility ◽

Empiric Antimicrobial Therapy

ABSTRACT The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

Download Full-text