Outcomes Associated with De-escalation of Antibiotics to Target Positive Cultures when Treating Febrile Neutropenia

Background: Patients with hematologic malignancies frequently develop febrile neutropenia (FN) and subsequently receive long courses of broad-spectrum antibiotics. Limited data is available on de-escalation strategies. Methods: This was a retrospective observational cohort study of adult patients wi...

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Veröffentlicht in:Journal of pharmacy practice 2024-04, Vol.37 (2), p.301-306
Hauptverfasser: Rainess, Rebecca, Campbell, Peter, Santamala, Jennifer, Kubin, Christine J., Mehta, Monica
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container_end_page 306
container_issue 2
container_start_page 301
container_title Journal of pharmacy practice
container_volume 37
creator Rainess, Rebecca
Campbell, Peter
Santamala, Jennifer
Kubin, Christine J.
Mehta, Monica
description Background: Patients with hematologic malignancies frequently develop febrile neutropenia (FN) and subsequently receive long courses of broad-spectrum antibiotics. Limited data is available on de-escalation strategies. Methods: This was a retrospective observational cohort study of adult patients with a hematologic malignancy, FN, and positive culture results from June 2017 to June 2020. A conventional group (patients who remained on empiric, broad-spectrum agents) was compared to a de-escalation group (patients whose antibiotic therapy was de-escalated based on culture results). The primary outcome was the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic. Results: Of the 123 patients included, the composite primary outcome occurred in 35.3% in the de-escalation group and 39.3% in the conventional group (P = .83). For secondary outcomes, median time to recurrent fever was 7 days in the de-escalation group and 7 days in the conventional group (P = .73). Incidence of Clostridioides difficile was 5.9% in the de-escalation group and 6.7% in the conventional group (P = 1.00). Development of multidrug resistant pathogens during hospital admission was 20.6% in the de-escalation group and 14.6% in the conventional group (P = .59). Median length of broad-spectrum antibiotics was 3 days in the de-escalation group and 8 days in the conventional group (P < .001). All-cause mortality within 30 days was 0 in the de-escalation group and 5.6% in the conventional group (P = .32). Conclusion: In a small sample of patients with a hematologic malignancy and FN, de-escalating antibiotics based on positive cultures decreased the duration of antibiotic therapy without increasing the rate of antibiotic failure.
doi_str_mv 10.1177/08971900221132120
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Limited data is available on de-escalation strategies. Methods: This was a retrospective observational cohort study of adult patients with a hematologic malignancy, FN, and positive culture results from June 2017 to June 2020. A conventional group (patients who remained on empiric, broad-spectrum agents) was compared to a de-escalation group (patients whose antibiotic therapy was de-escalated based on culture results). The primary outcome was the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic. Results: Of the 123 patients included, the composite primary outcome occurred in 35.3% in the de-escalation group and 39.3% in the conventional group (P = .83). For secondary outcomes, median time to recurrent fever was 7 days in the de-escalation group and 7 days in the conventional group (P = .73). Incidence of Clostridioides difficile was 5.9% in the de-escalation group and 6.7% in the conventional group (P = 1.00). Development of multidrug resistant pathogens during hospital admission was 20.6% in the de-escalation group and 14.6% in the conventional group (P = .59). Median length of broad-spectrum antibiotics was 3 days in the de-escalation group and 8 days in the conventional group (P &lt; .001). All-cause mortality within 30 days was 0 in the de-escalation group and 5.6% in the conventional group (P = .32). Conclusion: In a small sample of patients with a hematologic malignancy and FN, de-escalating antibiotics based on positive cultures decreased the duration of antibiotic therapy without increasing the rate of antibiotic failure.</description><identifier>ISSN: 0897-1900</identifier><identifier>EISSN: 1531-1937</identifier><identifier>DOI: 10.1177/08971900221132120</identifier><identifier>PMID: 36201023</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Anti-Bacterial Agents - therapeutic use ; Cohort Studies ; Febrile Neutropenia - drug therapy ; Hematologic Neoplasms - complications ; Hematologic Neoplasms - drug therapy ; Humans ; Retrospective Studies</subject><ispartof>Journal of pharmacy practice, 2024-04, Vol.37 (2), p.301-306</ispartof><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c340t-740dc6844a9b468052b43b032d65e1e26b7fc9c94eebb2243531a23b1c0c0723</citedby><cites>FETCH-LOGICAL-c340t-740dc6844a9b468052b43b032d65e1e26b7fc9c94eebb2243531a23b1c0c0723</cites><orcidid>0000-0001-6815-8048</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/08971900221132120$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/08971900221132120$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36201023$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rainess, Rebecca</creatorcontrib><creatorcontrib>Campbell, Peter</creatorcontrib><creatorcontrib>Santamala, Jennifer</creatorcontrib><creatorcontrib>Kubin, Christine J.</creatorcontrib><creatorcontrib>Mehta, Monica</creatorcontrib><title>Outcomes Associated with De-escalation of Antibiotics to Target Positive Cultures when Treating Febrile Neutropenia</title><title>Journal of pharmacy practice</title><addtitle>J Pharm Pract</addtitle><description>Background: Patients with hematologic malignancies frequently develop febrile neutropenia (FN) and subsequently receive long courses of broad-spectrum antibiotics. Limited data is available on de-escalation strategies. Methods: This was a retrospective observational cohort study of adult patients with a hematologic malignancy, FN, and positive culture results from June 2017 to June 2020. A conventional group (patients who remained on empiric, broad-spectrum agents) was compared to a de-escalation group (patients whose antibiotic therapy was de-escalated based on culture results). The primary outcome was the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic. Results: Of the 123 patients included, the composite primary outcome occurred in 35.3% in the de-escalation group and 39.3% in the conventional group (P = .83). For secondary outcomes, median time to recurrent fever was 7 days in the de-escalation group and 7 days in the conventional group (P = .73). Incidence of Clostridioides difficile was 5.9% in the de-escalation group and 6.7% in the conventional group (P = 1.00). Development of multidrug resistant pathogens during hospital admission was 20.6% in the de-escalation group and 14.6% in the conventional group (P = .59). Median length of broad-spectrum antibiotics was 3 days in the de-escalation group and 8 days in the conventional group (P &lt; .001). All-cause mortality within 30 days was 0 in the de-escalation group and 5.6% in the conventional group (P = .32). 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Limited data is available on de-escalation strategies. Methods: This was a retrospective observational cohort study of adult patients with a hematologic malignancy, FN, and positive culture results from June 2017 to June 2020. A conventional group (patients who remained on empiric, broad-spectrum agents) was compared to a de-escalation group (patients whose antibiotic therapy was de-escalated based on culture results). The primary outcome was the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic. Results: Of the 123 patients included, the composite primary outcome occurred in 35.3% in the de-escalation group and 39.3% in the conventional group (P = .83). For secondary outcomes, median time to recurrent fever was 7 days in the de-escalation group and 7 days in the conventional group (P = .73). Incidence of Clostridioides difficile was 5.9% in the de-escalation group and 6.7% in the conventional group (P = 1.00). Development of multidrug resistant pathogens during hospital admission was 20.6% in the de-escalation group and 14.6% in the conventional group (P = .59). Median length of broad-spectrum antibiotics was 3 days in the de-escalation group and 8 days in the conventional group (P &lt; .001). All-cause mortality within 30 days was 0 in the de-escalation group and 5.6% in the conventional group (P = .32). Conclusion: In a small sample of patients with a hematologic malignancy and FN, de-escalating antibiotics based on positive cultures decreased the duration of antibiotic therapy without increasing the rate of antibiotic failure.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>36201023</pmid><doi>10.1177/08971900221132120</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-6815-8048</orcidid></addata></record>
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subjects Adult
Anti-Bacterial Agents - therapeutic use
Cohort Studies
Febrile Neutropenia - drug therapy
Hematologic Neoplasms - complications
Hematologic Neoplasms - drug therapy
Humans
Retrospective Studies
title Outcomes Associated with De-escalation of Antibiotics to Target Positive Cultures when Treating Febrile Neutropenia
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