2426. Ceftaroline-Associated Neutropenia: Retrospective Study and Systematic Review of Incidence, Risk Factors, and Outcomes

BACKGROUND: Ceftaroline-associated neutropenia has been reported, but clinical data are limited. METHODS: We performed a retrospective study of ceftaroline-associated neutropenia within a large healthcare system and a comprehensive systematic review of the English literature (2010–2017) of published cases containing individualized case data to describe the incidence, risk factors, and outcomes associated with ceftaroline-associated neutropenia. Neutropenia was defined as an absolute neutrophil count (ANC) of <1,500 cells/mm(3). Cases with pre-existing neutropenia or other potential reason for the development neutropenia while on ceftaroline were excluded. RESULTS: A total of 37 cases of ceftaroline-associated neutropenia have been published. The median patient age was 44 years (range 20–90), 22 (59%) were female, and most were receiving ceftaroline for invasive Staphylococcus aureus infections. The median time from ceftaroline initiation to development of neutropenia was at 25 days (range 8–125 days). Agranulocytosis (ANC nadir <100 cells/mm(3)) developed in 49% of cases (n = 18) and an ANC nadir of 0 in 27% (n = 10). The median duration of neutropenia was an average of 4 days (range 1–16 days). Eleven (30%) received granulocyte-colony stimulating factor (G-CSF) treatment and ceftaroline was discontinued in all cases. The outcome was favorable in all cases, and only one case developed a secondary infection during neutropenia. Literature review of studies containing cases and controls (patients receiving drug but did not develop neutropenia) found an incidence of neutropenia of 12% (range 7–18% per individual study) when ceftaroline was utilized for ≥7–14 days, higher than for comparator antibiotics in the literature. Risk factors for the development of neutropenia during ceftaroline varied between studies and remains undefined. CONCLUSION: Neutropenia is common when ceftaroline is utilized for ≥14 days and close hematologic monitoring is warranted. Further research is needed to determine the mechanism and risk factors for the high incidence of neutropenia associated with long-term ceftaroline use. DISCLOSURES: All authors: No reported disclosures.