Petteys Megan M, Kachur Ekaterina, Pillinger Kelly E, He Jiaxian, Copelan Edward A, Shahid Zainab
Antimicrobial Support Network, Carolinas Medical Center, Charlotte, USA.
Department of Pharmacy, Levine Cancer Institute, Charlotte, USA.
J Oncol Pharm Pract. 2020 Apr;26(3):632-640. doi: 10.1177/1078155219865303. Epub 2019 Aug 18.
The optimal duration of empiric antimicrobial therapy in febrile neutropenia of unknown origin is unclear. This study evaluated outcomes in autologous and allogeneic hematopoietic cell transplantation recipients with febrile neutropenia of unknown origin who received early de-escalation of broad-spectrum antimicrobials prior to hematopoietic recovery versus those who continued broad-spectrum antimicrobials until hematopoietic recovery.
A single-center, retrospective study assessed hematopoietic cell transplantation recipients with febrile neutropenia of unknown origin. Patients were categorized into either cohort 1, representing early de-escalation prior to hematopoietic recovery, or cohort 2, representing continuation of broad-spectrum antimicrobials until hematopoietic recovery.
A total of 107 patients were included (22.4% in cohort 1 and 77.6% in cohort 2). Most patients (87.5%) in cohort 1 underwent haploidentical hematopoietic cell transplantation, whereas 84.3% of patients in cohort 2 received autologous hematopoietic cell transplantation. There were no significant differences in rates of recurrent fever (4.2% versus 7.2%, in cohorts 1 and 2, respectively, adjusted odds ratio = 0.84, = 0.85), re-escalation (4.2% versus 4.8%, adjusted odds ratio = 1.57, = 0.64), and -associated infections (4.2% versus 2.4%, adjusted odds ratio = 2.27, = 0.43). No patient experienced in-hospital mortality, intensive care unit admission, or bacteremia.
Hematopoietic cell transplantation recipients with febrile neutropenia of unknown origin in which broad-spectrum antimicrobials were de-escalated prior to hematopoietic recovery did not experience adverse outcomes. These results concur with recently published studies and the Fourth European Conference on Infections in Leukemia guidelines. An early de-escalation approach in haploidentical hematopoietic cell transplantation recipients specifically appears safe and may result in a reduction in antimicrobial utilization.
不明原因发热性中性粒细胞减少症经验性抗菌治疗的最佳疗程尚不清楚。本研究评估了不明原因发热性中性粒细胞减少症的自体和异基因造血细胞移植受者，比较了造血恢复前接受早期降阶梯广谱抗菌治疗的患者与持续使用广谱抗菌治疗直至造血恢复的患者的结局。
一项单中心回顾性研究评估了不明原因发热性中性粒细胞减少症的造血细胞移植受者。患者被分为两组，第1组代表造血恢复前早期降阶梯，第2组代表持续使用广谱抗菌治疗直至造血恢复。
共纳入107例患者（第1组占22.4%，第2组占77.6%）。第1组大多数患者（87.5%）接受了单倍体造血细胞移植，而第2组84.3%的患者接受了自体造血细胞移植。复发发热率（第1组和第2组分别为4.2%和7.2%，调整优势比=0.84，P=0.85）、再次升级率（4.2%对4.8%，调整优势比=1.57，P=0.64）和与[具体内容缺失]相关的感染率（4.2%对2.4%，调整优势比=2.27，P=0.43）无显著差异。无患者发生院内死亡、入住重症监护病房或菌血症。
不明原因发热性中性粒细胞减少症的造血细胞移植受者，在造血恢复前进行广谱抗菌药物降阶梯治疗，未出现不良结局。这些结果与最近发表的研究及第四届欧洲白血病感染会议指南一致。特别是在单倍体造血细胞移植受者中采用早期降阶梯方法似乎是安全的，且可能降低抗菌药物的使用。
