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253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia

BACKGROUND: The IDSA and NCCN guidelines recommend continuing IV anti-pseudomonal (IVPSA) therapy until neutrophil recovery (i.e., an ANC > 500 cells/mm(3)) in high-risk acute myeloid leukemia (AML) patients with febrile neutropenia (FN). This recommendation is based on expert opinion and the cur...

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Autores principales: Alegria, William, Marini, Bernard L, Perissinotti, Anthony J, Bixby, Dale, Gregg, Kevin, Nagel, Jerod
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254200/
http://dx.doi.org/10.1093/ofid/ofy210.264
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author Alegria, William
Marini, Bernard L
Perissinotti, Anthony J
Bixby, Dale
Gregg, Kevin
Nagel, Jerod
author_facet Alegria, William
Marini, Bernard L
Perissinotti, Anthony J
Bixby, Dale
Gregg, Kevin
Nagel, Jerod
author_sort Alegria, William
collection PubMed
description BACKGROUND: The IDSA and NCCN guidelines recommend continuing IV anti-pseudomonal (IVPSA) therapy until neutrophil recovery (i.e., an ANC > 500 cells/mm(3)) in high-risk acute myeloid leukemia (AML) patients with febrile neutropenia (FN). This recommendation is based on expert opinion and the current practice should be re-evaluated given the emergence of multi-drug-resistant organisms and high rates of Clostridium difficile infection (CDI) in this population. The purpose of this study was to evaluate whether IVPSA antibiotics could be safely de-escalated or discontinued in high-risk AML patients with FN following implementation of a guideline. METHODS: This single-center, pre–post quasi-experimental study included patients with AML receiving induction chemotherapy hospitalized between September 2015 to February 2018. Patients in the intervention group were compared with a historical cohort of patients admitted before implementation of the guideline. The primary outcome was the incidence of suspected or documented bacterial infection after antibiotic de-escalation in the intervention group (or meeting criteria for de-escalation in the historical control group). Secondary outcomes included the incidence of CDI, IVPSA Days of Therapy (DOTs), hospital length of stay (LOS), and mortality. Patients in the intervention group were evaluated for antibiotic de-escalation on day 5 of FN and antibiotics were discontinued if patients were afebrile, hemodynamically stable, and without evidence of infection irrespective of their ANC (or de-escalated to fluoroquinolone prophylaxis in relapsed/refractory disease). In clinically stable patients with suspected or documented bacterial infection, antibiotics were continued for a defined duration per indication as outlined in the guideline. RESULTS: A total of 93 patients were included in the analysis. Baseline demographics were similar between the two groups with the exception of more relapsed/refractory patients in the intervention group. Patients in the intervention group had similar clinical outcomes and lower rates of CDI and IVPSA DOTs (see Figure 1). CONCLUSION: In high-risk AML patients with FN, an antibiotic de-escalation guideline reduced the incidence of CDI and IVPSA antibiotic DOTs without adversely affecting clinical outcomes. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62542002018-11-28 253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia Alegria, William Marini, Bernard L Perissinotti, Anthony J Bixby, Dale Gregg, Kevin Nagel, Jerod Open Forum Infect Dis Abstracts BACKGROUND: The IDSA and NCCN guidelines recommend continuing IV anti-pseudomonal (IVPSA) therapy until neutrophil recovery (i.e., an ANC > 500 cells/mm(3)) in high-risk acute myeloid leukemia (AML) patients with febrile neutropenia (FN). This recommendation is based on expert opinion and the current practice should be re-evaluated given the emergence of multi-drug-resistant organisms and high rates of Clostridium difficile infection (CDI) in this population. The purpose of this study was to evaluate whether IVPSA antibiotics could be safely de-escalated or discontinued in high-risk AML patients with FN following implementation of a guideline. METHODS: This single-center, pre–post quasi-experimental study included patients with AML receiving induction chemotherapy hospitalized between September 2015 to February 2018. Patients in the intervention group were compared with a historical cohort of patients admitted before implementation of the guideline. The primary outcome was the incidence of suspected or documented bacterial infection after antibiotic de-escalation in the intervention group (or meeting criteria for de-escalation in the historical control group). Secondary outcomes included the incidence of CDI, IVPSA Days of Therapy (DOTs), hospital length of stay (LOS), and mortality. Patients in the intervention group were evaluated for antibiotic de-escalation on day 5 of FN and antibiotics were discontinued if patients were afebrile, hemodynamically stable, and without evidence of infection irrespective of their ANC (or de-escalated to fluoroquinolone prophylaxis in relapsed/refractory disease). In clinically stable patients with suspected or documented bacterial infection, antibiotics were continued for a defined duration per indication as outlined in the guideline. RESULTS: A total of 93 patients were included in the analysis. Baseline demographics were similar between the two groups with the exception of more relapsed/refractory patients in the intervention group. Patients in the intervention group had similar clinical outcomes and lower rates of CDI and IVPSA DOTs (see Figure 1). CONCLUSION: In high-risk AML patients with FN, an antibiotic de-escalation guideline reduced the incidence of CDI and IVPSA antibiotic DOTs without adversely affecting clinical outcomes. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254200/ http://dx.doi.org/10.1093/ofid/ofy210.264 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Alegria, William
Marini, Bernard L
Perissinotti, Anthony J
Bixby, Dale
Gregg, Kevin
Nagel, Jerod
253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia
title 253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia
title_full 253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia
title_fullStr 253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia
title_full_unstemmed 253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia
title_short 253. Febrile Neutropenia Antibiotic De-escalation Study in Acute Myeloid Leukemia Patients With Prolonged Neutropenia
title_sort 253. febrile neutropenia antibiotic de-escalation study in acute myeloid leukemia patients with prolonged neutropenia
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254200/
http://dx.doi.org/10.1093/ofid/ofy210.264
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