Sipahi O R, Arda B, Nazli-Zeka A, Pullukcu H, Tasbakan M, Yamazhan T, Ozkoren-Calik S, Sipahi H, Ulusoy S
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
Int J Clin Pract. 2014 Feb;68(2):230-5. doi: 10.1111/ijcp.12279. Epub 2013 Dec 22.
The aim of this study was to compare the efficacy of piperacillin/tazobactam (P/T) and cefoperazone/sulbactam (C/S) in the empirical treatment of adult neutropenic fever.
Data and outcomes of low-risk adult cases with neutropenic fever and treated with P/T (4.5 g q6h) or C/S (2 g q8h) between 2005 and 2011 June were extracted from our database. Risk evaluation was made according to criteria of Multinational Association for Supportive Care in Cancer (MASCC) and a score of ≥ 21 was considered as low risk. Data were collected prospectively by daily visits and evaluated retrospectively. Primary outcome was - fever defervescence at 72 h in combination with success without modification (referring to episodes where the patient recovered from fever with disappearance of signs of infection without modification to initial empirical treatment). All-cause mortality referred to death resulting from a documented or presumed infection or unidentified reason during the treatment and 30-day follow-up period.
A total of 172 patients (113 cases P/T and 59 cases C/S) fulfilled the study inclusion criteria. Persistent response in P/T arm was 73.5%, whereas it was 64.5% in C/S arm (p > 0.05). Rates of any modification were also similar in both treatment arms. All-cause mortality during the treatment and 30-day follow-up period was not significantly different (P/T: 4/113 vs. C/S: 2/59, p > 0.05). There was no severe adverse effect requiring antibiotic cessation in both cohorts.
In conclusion, our data suggest that C/S may be a safe alternative to P/T in the empirical treatment of adult low-risk febrile neutropenia cases.
本研究旨在比较哌拉西林/他唑巴坦（P/T）和头孢哌酮/舒巴坦（C/S）在成人中性粒细胞减少性发热经验性治疗中的疗效。
从我们的数据库中提取2005年至2011年6月期间接受P/T（4.5 g，每6小时一次）或C/S（2 g，每8小时一次）治疗的低风险成人中性粒细胞减少性发热病例的数据和结果。根据多国癌症支持治疗协会（MASCC）的标准进行风险评估，得分≥21分被视为低风险。数据通过每日访视前瞻性收集，并进行回顾性评估。主要结局是72小时时热退，且无需调整治疗方案即可成功（指患者发热消退且感染体征消失，无需调整初始经验性治疗方案的情况）。全因死亡率指治疗及为期30天的随访期间因记录在案或推测的感染或不明原因导致的死亡。
共有172例患者（113例P/T组和59例C/S组）符合研究纳入标准。P/T组的持续缓解率为73.5%，而C/S组为64.5%（p>0.05）。两个治疗组的任何调整率也相似。治疗及30天随访期间的全因死亡率无显著差异（P/T组：4/113 vs. C/S组：2/59，p>0.05）。两个队列中均未出现需要停用抗生素的严重不良反应。
总之，我们的数据表明，在成人低风险发热性中性粒细胞减少症病例的经验性治疗中，C/S可能是P/T的一种安全替代方案。
