Duration of empiric antibiotic therapy in granulocytopenic patients with cancer

Pizzo, Philip A.; Robichaud, K.J.; Gill, Fred A.; Witebsky, Frank G.; Levine, Arthur S.; Deisseroth, Albert; Glaubiger, Daniel; MacLowry, James D.; Magrath, Ian; Poplack, David G.; Simon, Richard

doi:10.1016/0002-9343(79)90390-5

Cited by 224 publications

(64 citation statements)

References 29 publications

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“…This is based on a study by Pizzo et al from 1979 which included very few patients and showed that stopping antibiotics on Day 7 of neutropenia resulted in significantly more infections and higher mortality (2 of 17 vs. 0 of 16 when antibiotics were administered until neutrophil recovery). 58 A later report maintained the empirical therapy for at least two afebrile days in patients with increasing neutrophil count or seven days in patients with persistent neutropenia. 59 Two more recent prospective studies in children found that discontinuation of antibiotics before marrow recovery did not increase fatality due to bacterial infections.…”

Section: Duration Of Antibiotic Therapy In Febrile Neutropeniamentioning

confidence: 99%

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

et al. 2013

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Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'deescalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance. ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3 increasing resistance. The draft of these guidelines was discussed by the Expert Group at the ECIL-4 meeting in September 2011 and considers: i) bacterial epidemiology in neutropenic patients; ii) risk factors for resistance; iii) escalation and deescalation approaches; iv) the appropriate duration of empirical therapy; iv) non-conventional therapies against multi-resistant pathogens; and v) other issues on the management of bacterial infections in these patients. Up-dated slide sets from ECIL-4 covering these aspects are available on the websites of the four organizations involved in ECIL: the European Group for Blood and Marrow Transplantation, the European Organisation for Research and Treatment of Cancer, the Immunocompromised Host Society (ECIL), and the European Leukaemia Net. 12,13 This article summarizes the main ECIL recommendations on the initial empirical therapy of bacterial infections, but will also be valuable for the management of the many nonneutropenic but severely-immunosuppressed hematology patients. MethodsThe methodology of the ECIL conferences has been described previously. 11A working group of experts in the field of infectious diseases, microbiology or hematology was constituted, and reviewed the published literature in order to prepare proposals covering the following aspects: 1) empirical antibiotic therapy for...

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Section: Duration Of Antibiotic Therapy In Febrile Neutropeniamentioning

confidence: 99%

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

et al. 2013

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“…Owing to the high-risk nature of these patients, empiric antibiotic treatment generally was continued until neutropenia resolved, regardless of the resolution of fevers. 18,19 Bacteremia without a focus was treated with intravenous antibiotics, the nature of the regimen being at the discretion of the treating physicians. All patients with suspected infection had blood cultures drawn on at least one occasion during the course of their treatment.…”

Section: Antibiotic Prophylaxis and Treatment Guidelinesmentioning

confidence: 99%

Invasive Pseudomonas aeruginosa infections: high rate of recurrence and mortality after hematopoietic cell transplantation

Hakki

Limaye

Kim

et al. 2007

Bone Marrow Transplant

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Limited data exist regarding the incidence and factors associated with outcome of invasive Pseudomonal infections in hematopoietic cell transplant (HCT). A retrospective analysis of cases of invasive Pseudomonas aeruginosa infection and factors associated with outcome was performed. P. aeruginosa invasive infection occurred in 95 of 5772 patients (1.65%) a median of 63 days after HCT (range 5-1435). Only 28% of infections occurred during periods of neutropenia (absolute neutrophil counto500 cells/mm 3 ). Infection-attributable mortality during the initial episode of infection was 35.8%. Factors associated with initial mortality included the presence of a copathogen and high-dose steroid use. Ten (16.4%) of those who survived the initial infection experienced a recurrence of P. aeruginosa infection at a median of 9 days (range 3-17) after stopping antibiotics and 60% of those died as a result of recurrent infection a median of 1 day (range 1-7) after onset of recurrence. Grade 3-4 graft-versus-host disease was associated with a higher risk of recurrent infection. The risk of recurrence was not influenced by the presence of copathogens. Thus, invasive P. aeruginosa infections are associated with high recurrence rates and mortality in this immunocompromised population. Aggressive attempts to reduce immunosuppression and to treat copathogens may help during the initial infection.

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“…Schimpff 4 confirmó estos datos, dentro del estudio que popularizó el concepto de doble cobertura para P. aeruginosa, que aún impera en muchos protocolos. En una época tan reciente como los años 80, Pizzo publicó dos brillantes estudios clínicos 5,6 que perfilaron el estándar actual, al introducirse dos nuevos conceptos: la adición de antifúngicos si la fiebre no se resuelve, y el mantenimiento de los antibióticos hasta la recuperación medular, para evitar las bacteriemias disruptivas. En 1989 la EORTC confirmó la utilidad de anfotericina B-deoxicolato, en pacientes con fiebre neutropénica mantenida 7 .…”

Section: Resultsunclassified

Neutropenia febril: análisis de los factores pronósticos y el tratamiento adaptado al riesgo. Revisión crítica

et al. 2006

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ResumenLos pacientes con neutropenia febril constituyen una población heterogénea. La tendencia actual de la mayoría de los grupos de trabajo consiste en tratar de ofrecer un tratamiento individualizado adaptado al riesgo de complicaciones. El aspecto más crítico se basa en encontrar las variables adecuadas para seleccionar a los enfermos de bajo riesgo. Desafortunadamente, los sistemas pronósticos más utilizados presentan una tasa de errores que se puede considerar inaceptable. Este estudio pretende analizar todos los factores pronósticos implicados en la confección de un algoritmo de tratamiento adaptado al riesgo, que incluya el manejo ambulatorio. Los factores pronósticos evaluados comprenden los sistemas clásicos de Talcott y Mascc, cuya utilidad pronóstica puede resultar controvertida. Además se analizan los fundamentos clínicos y microbiológicos de la neutropenia febril, y se propone la integración de todos estos datos, para conseguir una mayor fiabilidad en la evaluación de los pacientes.

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Duration of empiric antibiotic therapy in granulocytopenic patients with cancer

Cited by 224 publications

References 29 publications

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

Invasive Pseudomonas aeruginosa infections: high rate of recurrence and mortality after hematopoietic cell transplantation

Neutropenia febril: análisis de los factores pronósticos y el tratamiento adaptado al riesgo. Revisión crítica

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