Titre :

Discontinuation of antimicrobial therapy in adult neutropaenic haematology patients: a prospective cohort

Auteur(s) :

Van De Wyngaert, Zoe [Auteur]
Berthon, Celine [Auteur]
Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer (JPArc) - U1172
Debarri, Houria [Auteur]
Bories, Claire [Auteur]
Bonnet, Sarah [Auteur]
Nudel, Morgane [Auteur]
Carpentier, Benjamin [Auteur]
Legrand, Charline [Auteur]
Barbieux, Sarah [Auteur]
Chauvet, Paul [Auteur]
Simonnet, Arthur [Auteur]
Willaume, Alexandre [Auteur]
Bossard, Jean-Baptiste [Auteur]
Renaud, Loic [Auteur]
Wattebled, Kevin James [Auteur]
Escure, Guillaume [Auteur]
Branche, Nicolas [Auteur]
Arib, Ines [Auteur]
Titecat, Marie [Auteur]
Quesnel, Bruno [Auteur]
Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer (JPArc) - U1172
Alfandari, Serge [Auteur]

Titre de la revue :

International Journal of Antimicrobial Agents

Nom court de la revue :

Int. J. Antimicrob. Agents

Date de publication :

2019-03-01

ISSN :

1872-7913

Mot(s)-clé(s) en anglais :

febrile neutropenia
ECIL-4
Acute myeloid leukaemia
antibiotics discontinuation

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

OBJECTIVE: Antibiotics for febrile neutropenia (FN) in acute myeloid leukaemia (AML) patients undergoing intensive chemotherapy are usually maintained until neutropenia resolution, because of the risk of uncontrolled sepsis ...
Lire la suite >OBJECTIVE: Antibiotics for febrile neutropenia (FN) in acute myeloid leukaemia (AML) patients undergoing intensive chemotherapy are usually maintained until neutropenia resolution, because of the risk of uncontrolled sepsis in this vulnerable population. This leads to unnecessarily prolonged antimicrobial therapy. METHODS: Based on ECIL-4 recommendations, we modified our management strategy and discontinued antibiotics after a pre-established duration in patients treated for a first episode of FN between August 2014 and October 2017. RESULTS: Antibiotics were stopped during 62 FN episodes, and maintained in the control group (n = 13). Median age of patients was 54 years. A total of 39 (63%) patients received induction and 23 (37%) consolidation chemotherapy; 36 (58%) patients had fever of unknown origin. Median neutropenia length was 26 days (IQR 24-30). Antibiotics were started at day 9 (IQR 5-13). Most patients received piperacillin-tazobactam (56%) or cefepime (32%). Antimicrobial therapy was longer in the control group than in the policy compliant group, 10 (IQR 7-16) vs. 19 days (IQR 15-23), P = 0.0001. After antibiotics discontinuation, 20% patients experienced fever recurrence, within 5.5 days (IQR 3-7.5). None of these febrile episodes were severe and 80% patients remained afebrile, with neutrophil recovery occurring within 5 days (IQR 2-8.5). Overall, 287 antibiotics days were spared; this represents 49% of all days with antibiotics. No patient had died at day 30 from intervention; six died during late follow-up, two from graft-versus-host disease and four from relapsed or refractory leukaemia. CONCLUSIONS: Discontinuing antibiotics in neutropenic AML patients treated for a first episode of FN is safe, and results in significant antibiotic sparing.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

CNRS
Université de Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
• Miniaturisation pour la Synthèse, l'Analyse et la Protéomique (MSAP) - USR 3290

Date de dépôt :

2024-01-30T10:27:37Z