Current antimicrobial practice in febrile neutropenia across Europe and Asia: the EBMT Infectious Disease Working Party survey

Abstract

The aim of this survey was to summarize the current antimicrobial practice in febrile neutropenia and the presence of key aspects of antimicrobial stewardship. A questionnaire was sent to 567 centers, and complete responses were obtained from 194 (34.2%). Fluoroquinolone and co-trimoxazole prophylaxis are used in 57.1% and 89.1%, respectively. In 66.4%, the first-line empirical therapy is piperacillin/tazobactam, whereas 10.9% use carbapenems. Empirical combination therapy is used in stable patients without history of resistant pathogens in 37.4%. De-escalation to monotherapy is performed within 3 days in 35.3% and after 10 days in 19.1%. Empirical addition of a glycopeptide is performed when fever persists more than 2-3 days in 60.8%. Empirical escalation to a broader spectrum agent is performed when fever persists more than 3-5 days in 71.4%. In case of positive blood cultures with a susceptible pathogen and uncomplicated presentation, 76.7% of centers deescalate and 36.6% discontinue before neutrophil recovery. In fever of unknown origin with uncomplicated presentation, 54.1% of centers de-escalate and 49.5% discontinue before neutrophil recovery. Recommendations put forward in the ECIL guidelines are not widely implemented in clinical practice. Specific problems include overuse of carbapenems and combination therapy and unjustified addition of glycopeptides without further de-escalation or discontinuation.

A questionnaire survey on evaluation for penetration and compliance of the Japanese Guideline on Febrile Neutropenia among hematology-oncology physicians and surgeons

“…To comply with these recommendations presumably depends on multifactor, including patient condition, local healthcare-providing system, the evidence level, and healthcare economy. According to the questionnaire survey on antimicrobial practice for FN across European and Asian blood and marrow transplantation centers, about half of the centers responded to de-escalate or discontinue the first-line therapy when the fever of unknown origin with an uncomplicated presentation resolved by the treatment [9]. The disincentives should be investigated in more detail.…”

“…Febrile neutropenia (FN) is a potentially fatal infectious complication in cancer chemotherapy. Various guidelines were published abroad [1][2][3][4][5], some of which were evaluated for compliance with guideline recommendations and clinical outcomes [6][7][8][9]. The Japanese guideline (GL) on FN, developed by a multidisciplinary expert panel based on evidence from other guidelines, meta-analyses, and systematic reviews, was published in 2014 and revised in 2017 by the Japanese Society of Medical Oncology and is comparable to internationally accepted ones.…”

Multiple Myeloma Outpatient Transplant Program in the Era of Novel Agents: State-of-the-Art

“…The use of empiric antibacterial therapy must follow internationally accepted guidelines for patients with FN and haematologic malignancies (36)(37)(38). Empiric broad-spectrum antibacterial therapy should be initiated within 1 h of the clinical evaluation, and as soon as the fever workup was completed.…”

Ceftolozane-Tazobatam for febrile neutropenia treatment in hematologic malignancy patients colonized by multi-resistant Enterobacteriaceae: preliminary results from a prospective cohort study

“…in Europe is Piperacillin-Tazobactam (PIP-TAZ), either associated or not with an aminoglycoside, depending on the severity of symptoms. 3 However, this approach may be ineffective in colonized patients, and an up-front carbapenem-based approach or an early shift to a carbapenem treatment is often required. Consequently, a revision of the F.N.…”