Anti-pseudomonal beta-lactams for the initial, empirical, treatment of febrile neutropenia: comparison of beta-lactams

Paul, Mical; Yahav, Dafna; Bivas, Assaf; Fraser, Abigail; Leibovici, Leonard

doi:10.1002/14651858.cd005197.pub3

Cited by 52 publications

(57 citation statements)

References 107 publications

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“…Ceftazidime, cefepime, meropenem, imipenem-cilastatin and piperacillin-tazobactam showed similar efficacy, although the latter was associated with a lower mortality in a review of 44 trials. 130 According to a meta-analysis, the addition of aminoglycosides did not improve the outcome while it significantly increased renal failure rates. 131 Therefore, most of the guidelines recommend firmly a b-lactam monotherapy.…”

Section: Empirical Therapy In High Risk Patientsmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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Section: Empirical Therapy In High Risk Patientsmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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“…On the other hand, there are reports indicating that they reduce mortality in comparison to other beta-lactams containing carbapenems or piperacillin-tazobactam (26). In addition, more modification is required in patients receiving piperacillintazobactam in comparison to those who receive carbapenem (24).…”

Section: Discussionmentioning

confidence: 99%

High-risk febrile neutropenia and its management in childrenwith solid tumors and lymphoma

Köse¹,

Emiroğlu²,

Köksal³

2015

Turk J Med Sci

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IntroductionNeutropenia is a condition where the absolute neutrophil count (ANC) is lower than 1500 cells/µL or is expected to drop below 500 cells/µL within a 48-h time period. When classifying the condition, 1000-1500 ANC/µL is accepted as mild, 500-1000 ANC/µL is accepted as intermediary, and less than 500 ANC/µL is accepted as severe neutropenia. On the other hand, neutropenic fever is a condition where the body temperature is greater than 38 °C for more than 1 h or is measured to be higher than 38 °C twice during a 12-h period (1). The signs and occurrence of infection in a neutropenic patient are also evaluated as febrile neutropenia (FN), even if there is no fever (2).In this study, clinical characteristics, treatment results of the FN attacks occurring in our patients with lymphoma and solid tumors factors treated due to FN, and factors influencing clinical pursuit and treatment results were compared with the literature. Materials and methods Ethical declarationEthical approval of the study was granted by the scientific research ethics board of our university. PatientsIn this study, 94 high-risk FN attacks that occurred in 50 pediatric patients were examined retrospectively. Patients with lymphoma and solid tumors received chemotherapy for malignant disease in the Pediatric Hematology and Oncology Clinic between the years of 2011 and 2013. Criteria for exclusion from the studyPatients with one of the following factors were excluded from the study: leukemia, a neutrophil count and fever that did not comply with the criteria described below, the source of fever being thought to be noninfectious, the patient being older than 18, the patient having had received antibiotics during the last 10 days, and the administration of glycopeptide (GP) at the beginning.Background/aim: The clinical characteristics and treatment results of febrile neutropenia attacks that occurred in patients with lymphoma and solid tumors were analyzed. Materials and methods:A total of 50 patients with 94 high-risk attacks were evaluated for malignant diseases in this study. Results:The fever etiology was determined as clinical (50%), microbiological (5.31%), clinical-microbiological (5.31%), or unknown (39.3%). A few of the attacks (21.3%) were observed in lymphoma cases and 77.7% were observed in patients with solid tumors. Patients who were in remission had 59.6% of the attacks, and 39.4% occurred in patients not in remission. Among the groups tested, 73% (the imipenem/amikacin group) and 47.9% (the piperacillin-tazobactam/amikacin group) of patients were in remission. Glycopeptide addition rates in these groups were 22.2% and 40.8% and antifungal addition rates were 8.8% and 18.3%, respectively. Conclusion:Clinical progress was more problematic in patients who were not in remission during the attacks. This was due to the fact that some patients had other factors that placed them in the high-risk group, as well as increased C reactive protein and procalcitonin values on the first day. Therefore, it may not be accurate to associate the ...

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“…En la literatura científica está reportada la mortalidad general de la NF entre 6 y 20% 19,25,26 ; y está descrito que los factores de riesgo más importantes para su presentación incluyen edad avanzada, co-morbilidades, tipo de cáncer, número y clase de agentes mielo-supresores 7 . La NF es una complicación potencialmente fatal y costosa en pacientes que se encuentran en quimioterapia para cáncer 27 .…”

Section: Discussionunclassified

“…La NF es una complicación potencialmente fatal y costosa en pacientes que se encuentran en quimioterapia para cáncer 27 . En los tres meta-análisis mencionados al inicio, la mortalidad aumentó con el uso de cefepima, en comparación con la de otros -lactámicos, ponderadas en 26 y 44% 16,17,19 lo cual puso en duda la seguridad de este medicamento en esta entidad clínica. Sin embargo, la FDA realizó un nuevo meta-análisis 22 , que incluyó 50 estudios adicionales (776 pacientes), que no fueron incluidos en los meta-análisis publicados por Dafna Yahav, Mical Paul y cols.…”

Section: Discussionunclassified

“…Un tercer meta-análisis publicado por The Cochrane Collaboration en 2010, donde se analizan 21 estudios, evidenció una mortalidad significativamente superior con el uso de cefepima comparándose con carbapenémicos, ceftazidima y piperacilina/tazobactam (RR 1,39. IC 1,04-1,86) 19 . Finalmente, la US Food and Drug Administration (FDA) realizó un meta-análisis publicado en Clinical Infectious diseases en 2010, que evalúo la eficacia y seguridad de cefepima en sus diferentes indicaciones 20 abarcando también el subgrupo de NF, en el cual no se encontró aumento estadísticamente significativa en la mortalidad al usar cefepima 21,22 .…”

Section: Introductionunclassified

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Características demográficas, morbilidad y mortalidad de los pacientes adultos con neutropenia febril tratados con cefepima

Puentes

Quiroga

Támara

et al. 2012

Rev. chil. infectol.

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Demographics, morbidity, and mortality febrile neutropenic adult patients treated with cefepimeIntroduction: Cefepime efficacy for treatment of febrile neutropenia (FN) in cancer adult patients is a controversial issue. Objective: To describe the demographic characteristics and general mortality of patients suffering from febrile neutropenia treated with cefepime in a fourth-level Latin American hospital. Patients and Methods: A cross-sectional observational study was performed. Study settled at San Ignacio of Bogotá, Colombia. University Hospital from January 2004 to December 2008. Results: A total of 333 patients were treated with cefepime, of whom 125 had suffered FN and met pre established inclusion and exclusion criteria. The general mortality was 14.4%, which was similar to the overall mortality in FN in other reports. Conclusions: Although there is still no clarity regarding the efficacy of cefepime in FN, its use has not been restricted. This study did not identify an excess risk of mortality in patients treated with cefepime.

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Anti-pseudomonal beta-lactams for the initial, empirical, treatment of febrile neutropenia: comparison of beta-lactams

Cited by 52 publications

References 107 publications

Bloodstream infections in neutropenic cancer patients: A practical update

Bloodstream infections in neutropenic cancer patients: A practical update

High-risk febrile neutropenia and its management in childrenwith solid tumors and lymphoma

Características demográficas, morbilidad y mortalidad de los pacientes adultos con neutropenia febril tratados con cefepima

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