Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA 31701, USA.
Department of Pharmaceutical Services, UF Health Shands Cancer Hospital, Gainesville, FL 32608, USA.
Int J Infect Dis. 2018 Apr;69:88-93. doi: 10.1016/j.ijid.2018.02.016. Epub 2018 Mar 1.
The purpose of this study was to evaluate the use of empirical vancomycin for patients with neutropenic fever (NF) with regard to adherence to treatment guidelines.
Adult patients with a diagnosis of neutropenia, who met the definition of NF as per treatment guidelines, were identified. Use of vancomycin was evaluated as part of empirical therapy and again after 72h. Outcomes were assessed using descriptive statistics, the Chi-square or Fisher's exact test, and univariate exact logistic regression analyses.
Sixty-four patients were included. Overall, inappropriate empirical vancomycin use was observed in more than 30% of patients. Of 35 patients with indications for empirical vancomycin, only 68% received it. At 72h, appropriate vancomycin continuation, de-escalation, or discontinuation occurred in 21 of 33 patients. On univariate regression, hematological malignancy was associated with appropriate empirical vancomycin prescribing, whether initiating or withholding (odds ratio 4.0, 95% confidence interval 1.31-12.1). No variable was independently associated with inappropriate continuation at 72h.
There is poor guideline adherence to vancomycin prescribing as empirical therapy and at 72-h reassessment in patients with NF. Further efforts are needed to foster a more rational use of vancomycin in patients with NF.
本研究旨在评估经验性万古霉素治疗中性粒细胞减少性发热（NF）患者时，其治疗方案是否符合治疗指南。
本研究纳入了符合中性粒细胞减少症诊断标准、且符合治疗指南中 NF 定义的成年患者。将万古霉素的使用情况作为经验性治疗的一部分进行评估，并在 72 小时后再次评估。使用描述性统计、卡方检验或 Fisher 确切检验和单变量精确逻辑回归分析来评估结果。
共纳入 64 例患者。总体而言，超过 30%的患者存在经验性万古霉素使用不当的情况。在 35 例有经验性使用万古霉素指征的患者中，仅 68%的患者接受了治疗。在 72 小时时，33 例患者中有 21 例适当继续、降级或停止使用万古霉素。在单变量回归中，与经验性使用万古霉素（无论是起始使用还是停药）相关的因素为血液系统恶性肿瘤（比值比 4.0，95%置信区间 1.31-12.1）。没有任何变量与 72 小时时的不适当持续使用相关。
NF 患者的经验性万古霉素治疗和 72 小时再评估中，指南的遵循情况较差。需要进一步努力促进 NF 患者更合理地使用万古霉素。
