Ceftazidime-Avibactam for the Treatment of Febrile Neutropenia in HSCT Recipients and Acute Leukemia Patients Post Induction Chemotherapy

Abstract

Background Febrile neutropenia is a common and major complication in patients with acute leukemia or those undergoing hematopoietic stem cell transplantation (HSCT). Understanding patient characteristics and patterns of susceptibility in febrile neutropenia is essential to provide the appropriate antimicrobial therapy. First-line agents should have Pseudomonas coverage, but with the increase in multi-drug resistant organisms, ceftazidime-avibactam has emerged as a new therapy in febrile neutropenia. Methods This is a retrospective case-control study of a total of 300 admissions (143 patients) between January 2009 and December 2017. Patients with hematologic neoplasms and patients that underwent HSCT who satisfied the definition of febrile neutropenia and treated with ceftazidime-avibactam (CAZAVI) were included in the study. A bivariate regression model to explore independent predictors of septic shock and mortality was constructed. Results Patients who received ceftazidime-avibactam (CAZAVI) were more likely to have a microbiologically documented infection (59.0% vs. 28.3%). Almost all complications were significantly more frequent in the CAZAVI group, with sepsis being the most common, occurring in 59.0% of patients in the CAZAVI arm. Our multivariable logistic regression analysis showed that receiving CAZAVI was an independent risk factor for both sepsis and mortality (aOR 6.33 [95% CI 2.81–14.30] and 7.82 [2.63–23.26], respectively). Conclusion Knowing the most common organisms isolated during a neutropenic fever episode as well as the patterns of resistance, compounded with an understanding of the risk factors for morbidity and mortality in such a vulnerable population, is key to providing them with appropriate prophylactic and therapeutic management. In addition, more studies should be done on the effectiveness of ceftazidime-avibactam in treating febrile neutropenia in the population at hand.