Practicing Antimicrobial Stewardship: De-Escalating Antibiotics in Patients With Acute Myeloid Leukemia and Neutropenic Fever

Abstract

We compared risk of recurrent fever in patients with acute myeloid leukemia undergoing induction chemotherapy with febrile neutropenia without an infectious source in which antibacterials were de-escalated before neutrophil recovery versus continued. There was less recurrent fever when antibacterials were de-escalated early with no increased adverse events.

Approach to fever in patients with neutropenia: a review of diagnosis and management

“…However, clinicians involved with antimicrobial stewardship continue to advocate for shorter courses of optimal antibiotics with hopes of avoiding unnecessary use of broad-spectrum therapy and limiting antibacterial resistance in this patient population. 19 , 73 , 74 With the growing concern for antibiotic resistance and limited antibiotic development (10 for 20 initiative), it is imperative to reevaluate dated clinical practices in hopes of modernizing the standard of care. 74 , 75 Within the past 6 years since the ESMO guidelines were published, several studies have been published that shed light on appropriate paths forward for appropriate duration of empiric antibiotic therapy in patients presenting with FN ( Table 2 ).…”

“… 74 , 75 Within the past 6 years since the ESMO guidelines were published, several studies have been published that shed light on appropriate paths forward for appropriate duration of empiric antibiotic therapy in patients presenting with FN ( Table 2 ). 14 – 24 …”

“…However, these results should be viewed with caution as uncontrolled differences between the two groups (de-escalated vs no de-escalation) likely played a role in this result. 19 Schauwvlieghe and colleagues evaluated multiple clinical outcomes in AML and MDS patients with FUO whose antibiotics were discontinued after 72-h. Results from this study demonstrated that discontinuing antibiotics after 3 days of empiric treatment, regardless of defervescence, did not lead to more serious medical conditions (SMC) compared to the standard of care (12.5% vs 8.9%; p = 0.17).…”

“…Over the past decade, several new studies have examined patients with fever and neutropenia. [14][15][16][17][18][19][20][21][22][23][24] In order to best manage patients today, practitioners should be familiar with the most updated diagnostic and treatment information when considering best practices.…”

Multidrug Resistant Infections in Paediatric AML: An Ominous Sign of the Times to Come

“…Active antibiotic deescalation in AML, guided by microbiology reports, allows a reduction in broad-spectrum antibiotic usage without affecting clinical outcomes and must be followed wherever possible. 5 Fungal infections constitute the next biggest threat to patients with acute leukemia. Posaconazole provides effective antimold activity and is the agent of choice for most patients with AML.…”