a Department of Haematology , Brest Teaching Hospital , Brest , France.
b Department of Internal Medicine, Infectious Diseases and Haematology , Cornouaille Hospital Quimper , Quimper , France.
Infect Dis (Lond). 2018 Jul;50(7):539-549. doi: 10.1080/23744235.2018.1438649. Epub 2018 Feb 16.
Immediate empirical antibiotic therapy is mandatory in febrile chemotherapy-induced neutropenia, but its optimal duration is unclear, especially in patients with fever of unknown origin (FUO).
The primary objective of this 20-month prospective observational study was to evaluate the feasibility and safety of short-term antibiotic treatment in afebrile or febrile patients exhibiting FUO, irrespective of their neutrophil count. The secondary objective was to describe the epidemiology of all episodes of febrile neutropenia.
In the first phase of the study, empirical antibiotic therapy in FUO patients was stopped after 48 h of apyrexia, in accordance with European Conference on Infections in Leukaemia guidelines (n = 45). In the second phase of the study, antibiotics were stopped no later than day 5 for all FUO patients, regardless of body temperature or leukocyte count (n = 37).
Two hundred and thirty-eight cases of febrile neutropenia in 123 patients were included. Neither the composite endpoint (p = .11), nor each component (in-hospital mortality (p = .80), intensive care unit admission (p = 0.48), relapse of infection ≤48 h after discontinuation of antibiotics (p = .82)) differed between the two FUO groups. Violation of protocol occurred in 17/82 episodes of FUO without any major impact on statistical results. Twenty-six (57.3%) and 22 (59.5%) FUO episodes did not relapse during hospital-stay (p = 1), and nine (20%) and five (13.5%) presented another FUO, respectively. One hundred and fifty-six episodes of febrile neutropenia (65.5%) were clinically or microbiologically documented, including 85 bacteremia.
These results suggest that early discontinuation of empirical antibiotics in FUO is safe for afebrile neutropenic patients.
在发热性化疗诱导的中性粒细胞减少症中，立即经验性使用抗生素治疗是强制性的，但最佳持续时间尚不清楚，尤其是对于发热原因不明（FUO）的患者。
本 20 个月前瞻性观察性研究的主要目的是评估在发热或不发热的 FUO 患者中，无论其中性粒细胞计数如何，短期抗生素治疗的可行性和安全性。次要目的是描述所有发热性中性粒细胞减少症发作的流行病学。
在研究的第一阶段，根据欧洲白血病感染会议指南（n=45），在 FUO 患者退热后 48 小时停止经验性抗生素治疗。在研究的第二阶段，无论体温或白细胞计数如何，所有 FUO 患者均在第 5 天之前停止使用抗生素（n=37）。
纳入了 123 名患者的 238 例发热性中性粒细胞减少症。复合终点（p=0.11）和每个组成部分（住院期间死亡率（p=0.80）、重症监护病房入院（p=0.48）、抗生素停药后≤48 小时内感染复发（p=0.82））在两个 FUO 组之间没有差异。违反方案发生在 17/82 例 FUO 中，但对统计结果没有重大影响。26（57.3%）和 22（59.5%）FUO 发作在住院期间未复发（p=1），9（20%）和 5（13.5%）分别出现另一个 FUO。156 例发热性中性粒细胞减少症（65.5%）具有临床或微生物学依据，包括 85 例菌血症。
这些结果表明，在 FUO 中，对不发热的中性粒细胞减少患者早期停止经验性抗生素治疗是安全的。
