Bloodstream Infections in Hematologic Malignancy Patients With Fever and Neutropenia: Are Empirical Antibiotic Therapies in the United States Still Effective?

Authors

Andrea J Zimmer
Erica Stohs
Jane Meza
Christopher Arnold
John W Baddley
Pranatharthi Chandrasekar
Zeinab El Boghdadly
Carlos A Gomez
Eileen K Maziarz
Jose G Montoya
Steven Pergam
Kenneth V Rolston
Michael J Satlin
Gowri Satyanarayana
Shmuel Shoham
Lynne Strasfeld
Randy Taplitz
Thomas J Walsh
Jo-Anne H Young
Yuning Zhang
Alison G Freifeld

Publication Date

7-1-2022

Journal

Open Forum Infectious Diseases

Abstract

Background: Rising antimicrobial resistance rates may impact the efficacy of empirical antibiotic treatment for febrile neutropenia in high-risk cancer patients. Lacking contemporary data about the epidemiology, antibiotic resistance patterns, and clinical outcomes from bloodstream infections (BSIs) in US cancer patients, it is unclear if current guidelines remain relevant.

Methods: In a cross-sectional study, 14 US cancer centers prospectively identified BSIs in high-risk febrile neutropenic (FN) patients, including those receiving chemotherapy for hematologic malignancies or hematopoietic stem cell transplantation.

Results: Among 389 organisms causing BSI in 343 patients, there was an equal distribution of gram-negative (GN) and gram-positive (GP) bacteria, with variability across centers. Cefepime and piperacillin-tazobactam were the most commonly prescribed empirical antibiotics for FN, at 62% and 23%, respectively; a GP-directed agent was empirically included in nearly half of all FN episodes within the first 24 hours. Susceptibility to fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems was 49%, 84%, 88%, and 96%, respectively, among GN isolates. Critical illness (CrI), defined as a new requirement for mechanical ventilation, vasopressor, or death within 30 days, occurred in 15% and did not correlate with fluoroquinolone prophylaxis, organism type, initial antibiotics, or adequacy of coverage. Only severity of illness at presentation, signified by a Pitt bacteremia score ≥2, predicted for critical illness within 30 days. Mortality was 4% by day 7 and 10% overall.

Conclusions: In accordance with US guidelines, cefepime or piperacillin-tazobactam remain effective agents or empirical treatment for high-risk cancer patients with FN who are stable at presentation, maintaining high GN pathogen susceptibility and yielding excellent outcomes.

Keywords

bacteremia in cancer patients, bacteremia following chemotherapy, bloodstream infections, empirical antibiotics, febrile neutropenia

DOI

10.1093/ofid/ofac240

PMID

35854988

PMCID

PMC9277632

PubMedCentral® Posted Date

5-18-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes