Evaluating the use of meropenem in hematologic patients with febrile neutropenia

IF 2 4区医学 Q3 HEMATOLOGY

Mediterranean Journal of Hematology and Infectious Diseases Pub Date : 2023-10-30 DOI:10.4084/mjhid.2023.067

R.A. Stuurman, E. Jong, P.C.R. Godschalk, M.F. Corsten, J.E. Nagtegaal

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引用次数: 0

Abstract

Abstract Objectives The Antibiotic Stewardship Team of Meander Medical Centre (Meander MC) instigated a revaluation of its treatment protocol for hematologic patients admitted with febrile neutropenia. The current hospital protocol advises administering meropenem for 72 hours, followed by antibiotic therapy guided by microbiological cultures. In order to responsibly adjust the current empiric regimen, this study aimed to determine the frequency of bacteria resistant to alternative antibiotics, namely ceftazidime and piperacillin/tazobactam, in both surveillance and diagnostic cultures. Methods This retrospective, observational, single-centre study included adult patients with a hematologic malignancy and febrile neutropenia admitted between October 2018 and June 2021. Collected metadata included patient characteristics, surveillance and diagnostic culture results, and antibiotic use. Results A total of 100 patients were included. One or more bacteria resistant to ceftazidime or piperacillin/tazobactam were identified in blood and urine cultures in seven (7%) and one (1%) patients respectively. Conclusions Our results support the safe reduction of the use of meropenem by changing the empiric treatment protocol for patients with hematologic malignancy and febrile neutropenia. As this study showed a lower resistance frequency to piperacillin/tazobactam than to ceftazidime, this antibiotic is the recommended alternative.

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评价美罗培南在发热性中性粒细胞减少血液病患者中的应用

摘要# x0D;目标& # x0D;曲德医疗中心(曲德MC)的抗生素管理团队倡导重新评估其治疗方案的血液病人入院的发热性中性粒细胞减少症。目前的医院方案建议使用美罗培南72小时，然后在微生物培养指导下进行抗生素治疗。为了负责任地调整目前的经验方案，本研究旨在确定监测和诊断培养中对替代抗生素(即头孢他啶和哌拉西林/他唑巴坦)耐药的细菌频率。方法# x0D;这项回顾性、观察性、单中心研究纳入了2018年10月至2021年6月期间入院的血液恶性肿瘤和发热性中性粒细胞减少症的成年患者。收集的元数据包括患者特征、监测和诊断培养结果以及抗生素使用情况。结果# x0D;共纳入100例患者。分别在7例(7%)和1例(1%)患者的血液和尿液培养中发现一种或多种对头孢他啶或哌拉西林/他唑巴坦耐药的细菌。结论# x0D;我们的研究结果支持通过改变血液恶性肿瘤和发热性中性粒细胞减少患者的经验治疗方案来安全减少美罗培南的使用。由于本研究显示哌拉西林/他唑巴坦的耐药频率低于头孢他啶，因此推荐使用这种抗生素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mediterranean Journal of Hematology and Infectious Diseases Medicine-Hematology

CiteScore

4.20

自引率

6.20%

发文量

113

审稿时长

12 weeks

期刊介绍： Reciprocal interdependence between infectious and hematologic diseases (malignant and non-malignant) is well known. This relationship is particularly evident in Mediterranean countries. Parasitosis as Malaria, Leishmaniosis, B Hookworms, Teniasis, very common in the southeast Mediterranean area, infect about a billion people and manifest prevalently with anemia so that they are usually diagnosed mostly by experienced hematologist on blood or bone marrow smear. On the other hand, infections are also a significant problem in patients affected by hematological malignancies. The blood is the primary vector of HIV infection, which otherwise manifest with symptoms related to a reduction in T lymphocytes. In turn, infections can favor the insurgency of hematological malignancies. The causative relationship between Epstein-Barr virus infection, Helicobacter pylori, hepatitis C virus, HIV and lymphoproliferative diseases is well known.