RESUMO
BACKGROUND: Rising antibiotic resistance poses a challenge to the management of febrile neutropenia in patients with haematological malignancies receiving chemotherapy. 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. 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. 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. 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.
Assuntos
Antibacterianos/administração & dosagem , Neutropenia Febril/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Criança , Farmacorresistência Bacteriana , Neutropenia Febril/mortalidade , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: High dose Cyclophosphamide (Cy) and Vinorelbine Cyclophosphamide (Vino-Cy) are stem cell (SC) mobilisation options for patients with multiple myeloma (MM). We present a comparison of mobilisation outcomes using these regimens. PATIENTS AND METHODS: Vino-Cy patients received Vinorelbine 25â¯mg/m2 on day 1, cyclophosphamide 1500â¯mg/m2 on day 2, and pegylated GCSF on day 4 or GCSF 10â¯mcg/kg/day from day 4 onwards. Cy patients were given cyclophosphamide 4000â¯mg/m2 on day 1 and GCSF10â¯mcg/kg/day from day 5 onwards. The target CD34â¯+â¯SC collection was 5â¯×â¯106â¯per kg/BW. RESULTS: 149 patients were included. SC collection was lower in the Vino-Cy group (8.20â¯×â¯106/Kg BW) compared to the Cy group (11.43â¯×â¯106/Kg BW), with adjusted geometric mean ratio of 0.59 (95% CI 0.41 to 0.86, pâ¯=â¯0.006). Time taken to achieve an adequate PB SC count was shorter for Vino-Cy (9⯱â¯1â¯day compared to 12⯱â¯2â¯days for Cy, adjusted absolute mean difference -3.95, 95% CI -4.85 to -3.06, Pâ¯<â¯.001). Mobilisation related toxicities (in particular, neutropaenic fever) were greater for Cy. CONCLUSION: Vino-Cy is a potential alternative to Cy given the need for effective mobilisation protocols with acceptable toxicity.