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Impact of an alternating first-line antibiotics strategy in febrile neutropenia.
- Source :
-
PloS one [PLoS One] 2018 Nov 28; Vol. 13 (11), pp. e0208039. Date of Electronic Publication: 2018 Nov 28 (Print Publication: 2018). - Publication Year :
- 2018
-
Abstract
- Background: Rising antibiotic resistance poses a challenge to the management of febrile neutropenia in patients with haematological malignancies receiving chemotherapy.<br />Aim: We studied an alternating first-line antibiotic strategy to determine its impact on all-cause mortality and bacteremia rates in patients with febrile neutropenia.<br />Methods: An alternating first-line antibiotic strategy was established in mid-2013. Data for 2012 (before strategy implementation) and 2014 (post-strategy implementation) were compared. Antibiotic Heterogeneity Index (AHI) for each of the two time-periods was also calculated.<br />Findings: There were 2012 admissions (26082 patient-days) in 2012 and 1843 admissions (24331 patient-days) in 2014. There was no significant difference in the baseline characteristics of patients in the two groups. The defined daily doses (DDD) of cefepime (CEF) fell while the DDD of piperacillin-tazobactam (PTZ) rose in 2014 compared with 2012. Vancomycin DDD fell in 2014. The AHI was 0.466 in 2012 and 0.582 in 2014. The difference in all-cause mortality was not statistically significant. There was no difference in rates of bacteremia with CEF-resistant, PTZ-resistant and carbapenem-resistant gram-negative organisms in the two groups. Rates of new cases of Methicillin-resistant Staphylococcus aureus (MRSA) were 2.38/1000 and 2.59/1000 patient-days in 2012 and 2014 respectively. Rates of new cases of Vancomycin-resistant Enterococcus (VRE) were 1.84/1000 and 1.81/1000 patient-days in 2012 and 2014 respectively. There was no Carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in 2012 and 1 in 2014.<br />Conclusion: An alternating first-line antibiotic strategy resulted in an increase in antibiotic heterogeneity, without increasing mortality. There was also no significant increase in bacteremia rates.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Bacteremia drug therapy
Bacteremia mortality
Child
Drug Resistance, Bacterial
Febrile Neutropenia mortality
Female
Hematologic Neoplasms complications
Hematologic Neoplasms drug therapy
Humans
Male
Middle Aged
Practice Patterns, Physicians'
Treatment Outcome
Young Adult
Anti-Bacterial Agents administration & dosage
Febrile Neutropenia drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 13
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 30485357
- Full Text :
- https://doi.org/10.1371/journal.pone.0208039