Abstract
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.
Idarubicin, cytarabine, and nivolumab in patients with newly diagnosed acute myeloid leukaemia or high-risk myelodysplastic syndrome: a single-arm, phase 2 study