1671. Comparison of Anti-Anaerobic Antimicrobial Schemes in Patients with Febrile Neutropenia and Gastrointestinal Symptoms
Session: Poster Abstract Session: Pre-emptive Therapy in Transplantation and Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWEEK 1.pdf (290.0 kB)
  • Background: Empirical therapy with an antipseudomonal broad-spectrum antibiotic is part of the initial management of febrile neutropenia (FN). The anti-anaerobic coverage should be added to the initial treatment when gastrointestinal (GI) symptoms are present. However, the optimal anti-anaerobic antimicrobial treatment of patients with FN and GI symptoms is not well established.  

    Methods: We performed a prospective cohort study in a single tertiary hospital from October 2009 to August 2011 with the objective to compare the 28-day mortality between patients with FN and GI symptoms (diarrhea, abdominal pain, or perianal pain) treated with an antibiotic with antipseudomonal and anti-anaerobic activity in monotherapy (piperacillin-tazobactam or carbapenem) and those treated with the combination of cefepime and metronidazole. Kaplan-Meier curves were used for calculating time-dependent occurrence of death. For comparison between groups, the log-rank test was applied.

    Results: In total, 37 patients were evaluated (15 in the monotherapy arm and 22 in the combination therapy arm). The treatment with cefepime and metronidazole resulted in lower 28-day mortality compared with the piperacillin-tazobactan or carbapenem monotherapy (0% vs. 40%; log rank P = 0,002). The assessment of whether mortality was attributable to infection was concordant in all 6 patients who died.

    Conclusion: This study suggests a significant reduction in the mortality of patients with FN and gastrointestinal symptoms treated with cefepime plus metronidazole compared to monotherapy with piperacillin-tazobactan or carbapenem. Further randomized trials are warranted to confirm the better results with the combination therapy in patients with FN and GI symptoms.

    Figure. Survival Curves According to Antimicrobial Treatment in Patients with Febrile Neutropenia and Gastrointestinal Symptoms.

    Regis Rosa, M.D. M.S., PPG Em Ciências Médicas, Ufrgs - Faculty of Medicine, Porto Alegre, Brazil, Rodrigo Dos Santos, MD, Hospital De Clínicas De Porto Alegre, Porto Alegre, Brazil and Luciano Goldani, PhD, MD, Infectious Diseases Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

    Disclosures:

    R. Rosa, None

    R. Dos Santos, None

    L. Goldani, None

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