CHU Lille, Service des Maladies du Sang, Rue Michel Polonovski F-59000 Lille, France.
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.
Int J Antimicrob Agents. 2019 Jun;53(6):781-788. doi: 10.1016/j.ijantimicag.2019.02.020. Epub 2019 Mar 2.
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.
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.
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.
Discontinuing antibiotics in neutropenic AML patients treated for a first episode of FN is safe, and results in significant antibiotic sparing.
接受强化化疗的急性髓系白血病（AML）发热性中性粒细胞减少症（FN）患者的抗生素治疗通常持续到中性粒细胞减少症缓解，因为在这个脆弱的人群中，不受控制的败血症风险很高。这导致不必要的抗菌治疗时间延长。
根据 ECIL-4 建议，我们修改了管理策略，并在 2014 年 8 月至 2017 年 10 月期间对首次 FN 发作的患者治疗后，按照预先设定的时间停止抗生素治疗。
62 例 FN 发作期间停止使用抗生素，对照组（n=13）维持抗生素治疗。患者中位年龄为 54 岁。共有 39 例（63%）患者接受诱导和巩固化疗；23 例（37%）患者发热原因不明。中位中性粒细胞减少症持续时间为 26 天（IQR 24-30）。抗生素在第 9 天（IQR 5-13）开始。大多数患者接受哌拉西林他唑巴坦（56%）或头孢吡肟（32%）治疗。与符合政策组相比，对照组的抗生素治疗时间更长，分别为 10 天（IQR 7-16）和 19 天（IQR 15-23），P=0.0001。停止抗生素治疗后，20%的患者在 5.5 天内（IQR 3-7.5）出现发热复发。这些发热事件均不严重，80%的患者仍无发热，中性粒细胞恢复发生在 5 天内（IQR 2-8.5）。总体而言，节省了 287 天抗生素；这代表所有抗生素日的 49%。没有患者在第 30 天因干预而死亡；6 例患者在晚期随访中死亡，2 例死于移植物抗宿主病，4 例死于复发或难治性白血病。
在治疗首次 FN 的中性粒细胞减少症 AML 患者中停止使用抗生素是安全的，并可显著节省抗生素。
