Oral versus Intravenous Empirical Antimicrobial Therapy for Fever in Patients with Granulocytopenia Who Are Receiving Cancer Chemotherapy

Kern, Winfried V.; Cometta, A.; Bock, R. De; Langenaeken, J.; Paesmans, Marianne; Gaya, H.

doi:10.1056/nejm199907293410502

Cited by 341 publications

(120 citation statements)

References 38 publications

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“…The success rate was 86% in patients receiving ciprofloxacin plus amoxicillin-clavulanate and 84% in patients receiving ceftriaxone plus amikacin. 21 These data indicate that a significant proportion of patients with febrile episodes after high-dose chemotherapy and autologous SCT might be managed on an out-patient basis.…”

Section: Discussionmentioning

confidence: 89%

Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors

Reich

Mapara

Reichardt

et al. 2001

Bone Marrow Transplant

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patients (66 with solid tumor, 36 with lymphoma, 14 with multiple myeloma, one with acute leukemia) underwent 178 cycles of high-dose chemotherapy and autologous stem cell transplantation (ASCT) at our institution. We retrospectively analyzed the infectious complications that occurred after ASCT. Median duration of neutropenia (granulocyte count Ͻ0.5 × 10 9 /l ) was 8 days, the overall incidence of fever requiring antimicrobial treatment was 63%. 35.4% of patients had fever of unknown orign (FUO), whereas primary bacteremia occurred in 21.3%, pneumonia in 3.4% and severe skin infection in 1.1% of patients. Invasive fungal infections occurred in three, and enterocolitis in one patient. Infection was fatal in three patients (2.6%), in each case due to septic shock. The most frequently isolated pathogens were Grampositive cocci. Median time to defervescence with antimicrobial therapy was 4 days (6 days in patients with bacteremia or other severe infection, and 3 days in patients with FUO). First-line antimicrobial therapy was successful in 65% of patients with FUO and 30.6% of patients with documented infections. With respect to the incidence, type and clinical course of infection, no significant differences between patients with lymphoma or multiple myeloma and those with solid tumors were detected. Bone Marrow Transplantation (2001) 27, 525-529.

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Section: Discussionmentioning

confidence: 89%

Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors

Reich

Mapara

Reichardt

et al. 2001

Bone Marrow Transplant

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“…According to guidelines, a combination of ciprofloxacin and amoxicillin/clavulanate is an appropriate empirical therapy for outpatients who are at low risk of developing complications, provided that FQs have not been used in prophylaxis. 8,128 Additionally, in a double-blind prospective study, the comparison of moxifloxacin vs. the aforementioned regimen showed similar success rates (80% vs. 82%) and overall survival rates (99%) in the 2 arms, although GP BSIs and P. aeruginosa infections were more frequent in the moxifloxacin group. 129 In low-risk patients in whom an intravenous treatment is started, the suitable regimens include b-lactams active against P. aeruginosa, and a subsequent stepdown to oral therapy can be considered.…”

Section: Empirical Therapy In Low Risk Patientsmentioning

confidence: 88%

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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“…1 The risk and outcome of infection in patients with febrile neutropenia is mainly determined by the duration of neutropenia and the underlying disease. 2 It is common to see most of these disorders simultaneously occurring in a single patient.…”

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confidence: 99%

Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies

Çelebi

Akan

Akçağlayan

et al. 2000

Bone Marrow Transplant

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Summary:The risk and outcome of infection in febrile neutropenic patients is mainly determined by the duration of neutropenia, the underlying disease or the treatment. This study was undertaken to compare infections and the outcome after conventional chemotherapy (CCT), allogeneic PBSC transplantation (alloPBSCT) or autologous PBSC transplantation (autoPBSCT), during the period of neutropenia, in a single center. A total of 145 patients (50 in CCT group, 50 in alloPBSCT and 45 in autoPBSCT) were evaluated. In the alloPBSCT group, 86% of the patients (43/50), in the autoPBSCT group 93% of the patients (42/45) and in the CCT group 92% (46/50) of the patients had at least one febrile episode during their neutropenic period (P Ͼ 0.05). Microbiologically and/or clinically documented infection rates were 50% (25/50), 42% (19/45) and 48% (24/50) respectively. Gram-positive pathogens, mostly coagulase-negative staphylococci were the most frequent cause of bacteremias in all groups. The frequency of CNS infections was significantly higher in the alloPBSCT and autoPBSCT groups compared to the CCT group (P Ͻ 0.008 and P Ͻ 0.04, respectively). Catheter infections were frequent in the PBSCT groups and pulmonary infections were more frequent in the CCT group (P Ͻ 0.05). The CCT group needed longer antibiotic usage compared to the alloPBSCT group (P Ͻ 0.006). The duration of neutropenia and the type of treatment given, does not affect the rate of febrile episodes, but affects the type of infections in febrile neutropenic patients. Bone Marrow Transplantation (2000) 26, 211-214. Keywords: febrile neutropenia; allogeneic peripheral blood stem cell transplantation; autologous peripheral blood stem cell transplantation; chemotherapy Infectious complications are associated with morbidity and mortality in patients with malignancies. Currently, this complication occurs more frequently and is related to the increased use of high-dose treatment modalities, and stem

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Oral versus Intravenous Empirical Antimicrobial Therapy for Fever in Patients with Granulocytopenia Who Are Receiving Cancer Chemotherapy

Abstract: In low-risk patients with cancer who have fever and granulocytopenia, oral therapy with ciprofloxacin plus amoxicillin-clavulanate is as effective as intravenous therapy.

Cited by 341 publications

References 38 publications

Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors

Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors

Bloodstream infections in neutropenic cancer patients: A practical update

Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies

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