Zoé Van de Wyngaert1, Céline Berthon2, Houria Debarri3, Claire Bories3, Sarah Bonnet3, Morgane Nudel3, Benjamin Carpentier3, Charline Legrand3, Sarah Barbieux3, Paul Chauvet3, Arthur Simonnet3, Alexandre Willaume3, Jean-Baptiste Bossard3, Loic Renaud3, Kevin James Wattebled3, Guillaume Escure3, Nicolas Branche3, Ines Arib3, Marie Titecat4, Bruno Quesnel5, Serge Alfandari6. 1. CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France. Electronic address: zoe.vandewyngaert@aphp.fr. 2. CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France; INSERM, UMR-S 1172; Institut pour la recherche sur le Cancer de Lille, Place de Verdun, F-59000 Lille France. 3. CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France. 4. Service de bactériologie, Centre de biologie-pathologie, Rue du Pr Jules LECLERCQ, CHU de Lille, France. 5. CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France; INSERM, UMR-S 1172; Institut pour la recherche sur le Cancer de Lille, Place de Verdun, F-59000 Lille France; Univ. Lille, 2 Avenue Eugène Avinée, F-59000 Lille, France. 6. Service de réanimation et maladies infectieuses, CH Tourcoing, 59208 Tourcoing, France.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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 AMLpatients treated for a first episode of FN is safe, and results in significant antibiotic sparing.
Authors: A Schauwvlieghe; A Dunbar; E Storme; A Vlak; R Aerts; J Maertens; B Sciot; T Van Der Wel; G Papageorgiou; I Moors; J J Cornelissen; B J A Rijnders; T Mercier Journal: EClinicalMedicine Date: 2021-04-25