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Early discontinuation of empirical antibacterial therapy in febrile neutropenia: the ANTIBIOSTOP study.
Le Clech, Lenaïg; Talarmin, Jean-Philippe; Couturier, Marie-Anne; Ianotto, Jean-Christophe; Nicol, Christophe; Le Calloch, Ronan; Dos Santos, Stéphanie; Hutin, Pascal; Tandé, Didier; Cogulet, Virginie; Berthou, Christian; Guillerm, Gaëlle.
Afiliação
  • Le Clech L; a Department of Haematology , Brest Teaching Hospital , Brest , France.
  • Talarmin JP; b Department of Internal Medicine, Infectious Diseases and Haematology , Cornouaille Hospital Quimper , Quimper , France.
  • Couturier MA; b Department of Internal Medicine, Infectious Diseases and Haematology , Cornouaille Hospital Quimper , Quimper , France.
  • Ianotto JC; a Department of Haematology , Brest Teaching Hospital , Brest , France.
  • Nicol C; a Department of Haematology , Brest Teaching Hospital , Brest , France.
  • Le Calloch R; a Department of Haematology , Brest Teaching Hospital , Brest , France.
  • Dos Santos S; a Department of Haematology , Brest Teaching Hospital , Brest , France.
  • Hutin P; a Department of Haematology , Brest Teaching Hospital , Brest , France.
  • Tandé D; b Department of Internal Medicine, Infectious Diseases and Haematology , Cornouaille Hospital Quimper , Quimper , France.
  • Cogulet V; c Laboratory of Bacteriology , Brest Teaching Hospital , Brest , France.
  • Berthou C; d Department of Pharmacy , Brest Teaching Hospital , Brest , France.
  • Guillerm G; a Department of Haematology , Brest Teaching Hospital , Brest , France.
Infect Dis (Lond) ; 50(7): 539-549, 2018 07.
Article em En | MEDLINE | ID: mdl-29451055
INTRODUCTION: Immediate empirical antibiotic therapy is mandatory in febrile chemotherapy-induced neutropenia, but its optimal duration is unclear, especially in patients with fever of unknown origin (FUO). OBJECTIVES: The primary objective of this 20-month prospective observational study was to evaluate the feasibility and safety of short-term antibiotic treatment in afebrile or febrile patients exhibiting FUO, irrespective of their neutrophil count. The secondary objective was to describe the epidemiology of all episodes of febrile neutropenia. METHODS: In the first phase of the study, empirical antibiotic therapy in FUO patients was stopped after 48 h of apyrexia, in accordance with European Conference on Infections in Leukaemia guidelines (n = 45). In the second phase of the study, antibiotics were stopped no later than day 5 for all FUO patients, regardless of body temperature or leukocyte count (n = 37). RESULTS: Two hundred and thirty-eight cases of febrile neutropenia in 123 patients were included. Neither the composite endpoint (p = .11), nor each component (in-hospital mortality (p = .80), intensive care unit admission (p = 0.48), relapse of infection ≤48 h after discontinuation of antibiotics (p = .82)) differed between the two FUO groups. Violation of protocol occurred in 17/82 episodes of FUO without any major impact on statistical results. Twenty-six (57.3%) and 22 (59.5%) FUO episodes did not relapse during hospital-stay (p = 1), and nine (20%) and five (13.5%) presented another FUO, respectively. One hundred and fifty-six episodes of febrile neutropenia (65.5%) were clinically or microbiologically documented, including 85 bacteremia. CONCLUSIONS: These results suggest that early discontinuation of empirical antibiotics in FUO is safe for afebrile neutropenic patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Suspensão de Tratamento / Febre de Causa Desconhecida / Neutropenia Febril / Antibacterianos Tipo de estudo: Guideline / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Infect Dis (Lond) Ano de publicação: 2018 Tipo de documento: Article País de afiliação: França

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Suspensão de Tratamento / Febre de Causa Desconhecida / Neutropenia Febril / Antibacterianos Tipo de estudo: Guideline / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Infect Dis (Lond) Ano de publicação: 2018 Tipo de documento: Article País de afiliação: França