Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

Gafter‐Gvili, Anat; Fraser, Abigail; Wetering, Marianne D. van de; Kremer, Leontien C. M.; Leibovici, Leonard

doi:10.1002/14651858.cd004386.pub2

Cited by 83 publications

(83 citation statements)

References 146 publications

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“…102 Since few studies have been performed in the last decade, an update of this meta-analysis did not report any significant changes. 103 Of note, 2 recent meta-analyses, one involving exclusively HSCT recipients (over 1400 patients, mostly after autologous HSCT) and the other including only randomized placebo-controlled and blinded studies failed to show significant survival benefit of FQ prophylaxis. 104,105 Moreover, there are growing concerns about a worldwide increase in resistance to FQs, and, consequently, the efficacy and ecological impact of FQ prophylaxis.…”

Section: Othersmentioning

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: Othersmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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“…17 Although prophylaxis with quinolones exerts a significant selection pressure for colonization and infection by fluoroquinolone-resistant organisms, a recent Cochrane review confirmed earlier meta-analyses that the reduction in mortality and infection rates in high-risk patients still outweighs the risk of resistance, the costs and occasional adverse events. 22 Nevertheless, quinolone prophylaxis should be employed only in selected high-risk patients, not in all neutropenic patients. 12,17 4.…”

Section: This Issue Of Haematologica 21mentioning

confidence: 99%

The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients

Gyssens¹,

Kern

Livermore

2013

Haematologica

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“…9 Therefore, it seems reasonable to deduce the recommendations from the large number of randomized controlled clinical trials and the respective meta-analyses, which are available for other neutropenic conditions. [10][11][12][13][14][15] If the patient's condition allows (ECOG (Eastern Cooperative Oncology Group) performance status 0-2), the evaluation of patients with the possible diagnosis of AA can be performed as an outpatient.…”

Section: Prevention Of Infections By General Medical Management Of Aamentioning

confidence: 99%

Supportive care in severe and very severe aplastic anemia

Höchsmann

Moicean

Risitano

et al. 2012

Bone Marrow Transplant

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for the EBMT Working Party on Aplastic AnemiaOptimal management of aplastic anemia (AA) is not confined to immediate diagnosis, early decision making and timely initiation of major treatment strategies (immunosuppression or SCT) but also involves supportive treatment as a crucial part of patient care. Patients are threatened by complications of cytopenia. Here, we summarize current recommendations for prevention and early treatment of fungal, bacterial and viral infections, transfusion strategy and iron chelation and assess the evidence basis. In fact, many recommendations for patients with AA are not based on randomized studies in AA itself, but they are deduced from other conditions with similar severity of cytopenia. Prevention and treatment of complications like hemorrhage, bacterial and fungal infections and of secondary events like alloimmunization to blood products and iron overload have a significant impact on the prognosis of AA patients and need to be carefully observed in daily practice. More controlled studies on supportive care should be performed in this rare disease.Bone Marrow Transplantation (2013) 48, 168-173; doi:10.1038/bmt.2012.220; published online 3 December 2012Keywords: aplastic anemia; supportive treatment; infection; transfusion; hematopoietic growth factors INTRODUCTION Survival of patients with aplastic anemia (AA) after both immunosuppression and allogeneic BMT improved substantially over the past 30 years. 1 For patients who received immunosuppression, this improvement was not restricted to patients who responded to the specific treatment. 2 Remarkably, the prognosis of non-responders to initial immunosuppression also improved substantially over time. 2 This is most likely due to the impact of supportive treatment on the overall survival of patients. The individual risk of a patient is mainly determined by the neutrophil, and monocyte counts. 2-8 During the past two decades, infection-related mortality and invasive fungal infections decreased. 2 However, infections are still the major threat for patients with severe or very severe AA. In the most recently published large clinical trials in AA, the most prevalent complications and the major causes of death still were bacterial and fungal infections. [3][4][5] In the following sections, we will summarize recommendations on the major aspects of supportive treatment in AA, that is, prophylaxis and early treatment of infections, transfusion strategy and treatment of iron overload.

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Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

Cited by 83 publications

References 146 publications

Bloodstream infections in neutropenic cancer patients: A practical update

Bloodstream infections in neutropenic cancer patients: A practical update

The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients

Supportive care in severe and very severe aplastic anemia

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