1423. Retrospective comparison of doripenem and cefepime in the empiric treatment of adult patients with febrile neutropenia
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • ID week poster.pdf (1.7 MB)
  • Background: Febrile neutropenia is a frequent complication of chemotherapy used for hematologic and solid malignancies. Empiric use of broad-spectrum anti-pseudomonal beta-lactam antibiotics is the accepted initial therapy of febrile neutropenia. Cefepime and carbapenems, including imipenem/cilastatin and meropenem, are recommended in this setting. Doripenem, another broad-spectrum carbapenem with improved anti-pseudomonal activity, has not been studied in febrile neutropenia, but is the standard formulary carbapenem in our hospital. We wished to retrospectively compare empiric therapy of febrile neutropenia with cefepime or doripenem plus Gram-positive-active coverage.

    Methods: Retrospective, single-center cohort study at 661-bed academic medical center with a bone marrow transplantation unit, conducted between October, 2007 and October, 2011. The records of 100 randomly selected patients with febrile neutropenia were reviewed. 50 patients received doripenem and 50 patients received cefepime. Almost all patients received Gram-positive-active coverage as well. All patients had an absolute neutrophil count of <500. The choice of antibiotics was at the discretion of the attending physician.

    Results: Mean patient ages in the doripenem and cefepime groups were 54.2 and 58.2 years, respectively. Time to defervescence in the doripenem and cefepime groups (median 3.2 vs 2.7 days, respectively) and administration of empiric Gram-positive-active antibiotics (100% vs 98%, respectively) did not differ significantly between the two groups. Additionally, duration of treatment (median 11.9 vs 9.7 days) and in-hospital mortality (10% vs 12%) were not significantly different between the doripenem and cefepime groups, respectively.

    Conclusion: Doripenem and cefepime both yielded similar patient outcomes, including time to defervescence, administration of Gram-positive-active antibiotics, duration of therapy, and in-hospital mortality, when compared in adults with febrile neutropenia following chemotherapy.

    Kashif Memon, M.D.1, Kerry Cleveland, MD, FACP1, Michael Gelfand, MD1, Gopikishan Rangaraj, MD1 and Wonsuk Yoo, Ph.D.2, (1)Infectious Diseases, University of Tennessee Health Sciences Center, Memphis, TN, (2)Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN

    Disclosures:

    K. Memon, None

    K. Cleveland, None

    M. Gelfand, None

    G. Rangaraj, None

    W. Yoo, None

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