Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia
Introduction: Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has been recommended that patients with FN receiving empiric antibiotics should be re-e...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-12-01
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| Series: | Journal of Global Infectious Diseases |
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| Online Access: | https://journals.lww.com/10.4103/jgid.jgid_192_23 |
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| author | Tyler Luu Austin Fan Reid Shaw Hina Dalal Jenna Adams Maressa Santarossa Gail Reid Stephanie Tsai Nina M. Clark Fritzie S. Albarillo |
| author_facet | Tyler Luu Austin Fan Reid Shaw Hina Dalal Jenna Adams Maressa Santarossa Gail Reid Stephanie Tsai Nina M. Clark Fritzie S. Albarillo |
| author_sort | Tyler Luu |
| collection | DOAJ |
| description | Introduction:
Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has been recommended that patients with FN receiving empiric antibiotics should be re-evaluated for safe antibiotic de-escalation.
Methods:
Subjects treated with meropenem for febrile neutropenia who met Loyola University Medical Center’s (LUMC) criteria for de-escalation were stratified based on whether meropenem was de-escalated, and 30-day all-cause mortality for both groups was assessed.
Results:
181 patients met criteria for meropenem de-escalation. Sixty patients (31.3%) were ade-escalated (MDE), and 121 subjects were not (NDE). The 30-day all-cause mortality was 8.3% (n = 5/60 subjects) in the MDE group and 2.4% (n = 3/121) in the NDE group but was not statistically significant (P=0.1). Median hospital length of stay was 13 days in the MDE group versus 20 days in the NDE group (P = 0.049). CDI rate was also lower in the de-escalated group. In addition, consultations by infectious diseases physicians were more common in the de-escalation group. Logistic regression model demonstrated positive culture (OR 4.78, P = 0.03), including positive blood culture (OR 8.05, P = 0.003), and GVHD (OR 19.44, P = 0.029), and were associated with high rates of appropriate de-escalation. Immunosuppression (OR 0.22, P = 0.004) was associated with lower rates of appropriate de-escalation.
Conclusion:
Appropriate meropenem de-escalation in FN patients is safe and can result in improved clinical outcomes. |
| format | Article |
| id | doaj-art-a38f07db7dd445499a39ac2f2ee5357e |
| institution | Kabale University |
| issn | 0974-777X 0974-8245 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Global Infectious Diseases |
| spelling | doaj-art-a38f07db7dd445499a39ac2f2ee5357e2025-01-07T07:10:17ZengWolters Kluwer Medknow PublicationsJournal of Global Infectious Diseases0974-777X0974-82452024-12-0116414515110.4103/jgid.jgid_192_23Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile NeutropeniaTyler LuuAustin FanReid ShawHina DalalJenna AdamsMaressa SantarossaGail ReidStephanie TsaiNina M. ClarkFritzie S. AlbarilloIntroduction: Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has been recommended that patients with FN receiving empiric antibiotics should be re-evaluated for safe antibiotic de-escalation. Methods: Subjects treated with meropenem for febrile neutropenia who met Loyola University Medical Center’s (LUMC) criteria for de-escalation were stratified based on whether meropenem was de-escalated, and 30-day all-cause mortality for both groups was assessed. Results: 181 patients met criteria for meropenem de-escalation. Sixty patients (31.3%) were ade-escalated (MDE), and 121 subjects were not (NDE). The 30-day all-cause mortality was 8.3% (n = 5/60 subjects) in the MDE group and 2.4% (n = 3/121) in the NDE group but was not statistically significant (P=0.1). Median hospital length of stay was 13 days in the MDE group versus 20 days in the NDE group (P = 0.049). CDI rate was also lower in the de-escalated group. In addition, consultations by infectious diseases physicians were more common in the de-escalation group. Logistic regression model demonstrated positive culture (OR 4.78, P = 0.03), including positive blood culture (OR 8.05, P = 0.003), and GVHD (OR 19.44, P = 0.029), and were associated with high rates of appropriate de-escalation. Immunosuppression (OR 0.22, P = 0.004) was associated with lower rates of appropriate de-escalation. Conclusion: Appropriate meropenem de-escalation in FN patients is safe and can result in improved clinical outcomes.https://journals.lww.com/10.4103/jgid.jgid_192_23clostridioides difficile infectionempiric antibiotic therapyfebrile neutropeniahematological disordersmeropenem |
| spellingShingle | Tyler Luu Austin Fan Reid Shaw Hina Dalal Jenna Adams Maressa Santarossa Gail Reid Stephanie Tsai Nina M. Clark Fritzie S. Albarillo Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia Journal of Global Infectious Diseases clostridioides difficile infection empiric antibiotic therapy febrile neutropenia hematological disorders meropenem |
| title | Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia |
| title_full | Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia |
| title_fullStr | Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia |
| title_full_unstemmed | Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia |
| title_short | Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia |
| title_sort | improved clinical outcomes with appropriate meropenem de escalation in patients with febrile neutropenia |
| topic | clostridioides difficile infection empiric antibiotic therapy febrile neutropenia hematological disorders meropenem |
| url | https://journals.lww.com/10.4103/jgid.jgid_192_23 |
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