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- Title
Outcomes Associated with De-escalation of Antibiotics to Target Positive Cultures when Treating Febrile Neutropenia.
- Authors
Rainess, Rebecca; Campbell, Peter; Santamala, Jennifer; Kubin, Christine J.; Mehta, Monica
- Abstract
Background: Patients with hematologic malignancies frequently develop febrile neutropenia (FN) and subsequently receive long courses of broad-spectrum antibiotics. Limited data is available on de-escalation strategies. Methods : This was a retrospective observational cohort study of adult patients with a hematologic malignancy, FN, and positive culture results from June 2017 to June 2020. A conventional group (patients who remained on empiric, broad-spectrum agents) was compared to a de-escalation group (patients whose antibiotic therapy was de-escalated based on culture results). The primary outcome was the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic. Results: Of the 123 patients included, the composite primary outcome occurred in 35.3% in the de-escalation group and 39.3% in the conventional group (P =.83). For secondary outcomes, median time to recurrent fever was 7 days in the de-escalation group and 7 days in the conventional group (P =.73). Incidence of Clostridioides difficile was 5.9% in the de-escalation group and 6.7% in the conventional group (P = 1.00). Development of multidrug resistant pathogens during hospital admission was 20.6% in the de-escalation group and 14.6% in the conventional group (P =.59). Median length of broad-spectrum antibiotics was 3 days in the de-escalation group and 8 days in the conventional group (P <.001). All-cause mortality within 30 days was 0 in the de-escalation group and 5.6% in the conventional group (P =.32). Conclusion: In a small sample of patients with a hematologic malignancy and FN, de-escalating antibiotics based on positive cultures decreased the duration of antibiotic therapy without increasing the rate of antibiotic failure.
- Subjects
BLOOD; FEBRILE neutropenia; CELL culture; SCIENTIFIC observation; MORTALITY; DEPRESCRIBING; RETROSPECTIVE studies; ACQUISITION of data; TREATMENT duration; TREATMENT effectiveness; CANCER patients; DISEASE relapse; CLOSTRIDIUM diseases; HEMATOLOGIC malignancies; MEDICAL records; MULTIDRUG resistance; DESCRIPTIVE statistics; ANTIBIOTICS; LONGITUDINAL method; DISEASE complications
- Publication
Journal of Pharmacy Practice, 2024, Vol 37, Issue 2, p301
- ISSN
0897-1900
- Publication type
Article
- DOI
10.1177/08971900221132120