RESUMEN
BACKGROUND: Early antibiotic discontinuation according to the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations is not systematically applied in high-risk neutropenic patients with haematological malignancies. METHODS: A retrospective multicentre observational study was conducted over 2â years to evaluate the safety of early antibiotic discontinuation for fever of unknown origin (FUO) during neutropenia after induction chemotherapy or HSCT, in comparison with a historical cohort. We used Cox proportional hazards models, censored on neutropenia resolution, to analyse factors associated with febrile recurrence. RESULTS: Among 147 included patients in the ECIL-4 cohort, mainly diagnosed with acute leukaemia (nâ=â104, 71%), antibiotics were discontinued during 170 post-chemotherapy neutropenic episodes. In comparison with the historical cohort of 178 episodes of neutropenia without antibiotic discontinuation, no significant differences were observed regarding febrile recurrences [71.2% (121/170) versus 71.3% (127/178), Pâ=â0.97], admission in ICUs [6.5% (11/170) versus 11.2% (20/178), Pâ=â0.17], septic shock [0.6% (1/170) versus 3.9% (7/178), Pâ=â0.07] and 30â day mortality [1.4% (2/147) versus 2.7% (4/150), Pâ=â0.084]. In the ECIL-4 cohort, the rate of bacteraemia in case of febrile recurrence was higher [27.1% (46/170) versus 11.8% (21/178), Pâ<â0.01] and antibiotic consumption was significantly lower (15.5 versus 19.9â days, Pâ<â0.001). After early antibiotic discontinuation according to ECIL-4 recommendations, enterocolitis was associated with febrile recurrence [HRâ=â2.31 (95% CIâ=â1.4-3.8), Pâ<â0.001] and stage III-IV oral mucositis with bacteraemia [HRâ=â2.26 (95% CIâ=â1.22-4.2), Pâ=â0.01]. CONCLUSIONS: After an FUO episode in high-risk neutropenia, compliance with ECIL-4 recommendations for early antibiotic discontinuation appears to be safe and mucosal damage was associated with febrile recurrence and bacteraemia. Prospective interventional studies are warranted to assess this strategy in high-risk neutropenic patients.