Luu Tyler, Fan Austin, Shaw Reid, Dalal Hina, Adams Jenna, Santarossa Maressa, Reid Gail, Tsai Stephanie, Clark Nina M, Albarillo Fritzie S
Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
Department of Medicine, Division of Infectious Diseases, UCLA, Los Angeles, CA, USA.
J Glob Infect Dis. 2024 Dec 21;16(4):145-151. doi: 10.4103/jgid.jgid_192_23. eCollection 2024 Oct-Dec.
Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has been recommended that patients with FN receiving empiric antibiotics should be re-evaluated for safe antibiotic de-escalation.
Subjects treated with meropenem for febrile neutropenia who met Loyola University Medical Center's (LUMC) criteria for de-escalation were stratified based on whether meropenem was de-escalated, and 30-day all-cause mortality for both groups was assessed.
181 patients met criteria for meropenem de-escalation. Sixty patients (31.3%) were ade-escalated (MDE), and 121 subjects were not (NDE). The 30-day all-cause mortality was 8.3% ( = 5/60 subjects) in the MDE group and 2.4% ( = 3/121) in the NDE group but was not statistically significant (=0.1). Median hospital length of stay was 13 days in the MDE group versus 20 days in the NDE group ( = 0.049). CDI rate was also lower in the de-escalated group. In addition, consultations by infectious diseases physicians were more common in the de-escalation group. Logistic regression model demonstrated positive culture (OR 4.78, = 0.03), including positive blood culture (OR 8.05, = 0.003), and GVHD (OR 19.44, = 0.029), and were associated with high rates of appropriate de-escalation. Immunosuppression (OR 0.22, = 0.004) was associated with lower rates of appropriate de-escalation.
Appropriate meropenem de-escalation in FN patients is safe and can result in improved clinical outcomes.
抗生素管理是治疗发热性中性粒细胞减少症（FN）癌症患者的关键环节，可限制耐药菌的产生并将药物不良反应降至最低。因此，建议对接受经验性抗生素治疗的FN患者进行重新评估，以安全地降低抗生素级别。
根据美罗培南是否进行降阶梯治疗，将符合洛约拉大学医学中心（LUMC）降阶梯标准的因发热性中性粒细胞减少症接受美罗培南治疗的患者进行分层，并评估两组的30天全因死亡率。
181例患者符合美罗培南降阶梯标准。60例患者（31.3%）进行了降阶梯治疗（MDE），121例未进行降阶梯治疗（NDE）。MDE组的30天全因死亡率为8.3%（n = 5/60例患者），NDE组为2.4%（n = 3/121），但差异无统计学意义（P = 0.1）。MDE组的中位住院时间为13天，而NDE组为20天（P = 0.049）。降阶梯治疗组的艰难梭菌感染率也较低。此外，降阶梯治疗组传染病医生的会诊更为常见。逻辑回归模型显示，培养阳性（比值比[OR]4.78，P = 0.03），包括血培养阳性（OR 8.05，P = 0.003）和移植物抗宿主病（GVHD，OR 19.44，P = 0.029），与适当降阶梯治疗的高发生率相关。免疫抑制（OR 0.22，P = 0.004）与适当降阶梯治疗的低发生率相关。
对FN患者进行适当的美罗培南降阶梯治疗是安全的，并且可以改善临床结局。
