As ESBL producing Enterobacteriaceae are emerging common pathogens in febrile neutropenia, choosing the empirical antimicrobial therapy has become a challenge. Carbapenem is recommend as first line treatment of ESBL-producing Enterobacteriacea infection and empirical treatment of neutropenic fever. Nevertheless, considering the emergence of carbapenemase-producing organism, physicians should hesitate to prescribe. Combination aminoglycoside with beta-lactam has suggested as initial regimen of neutropenic fever in high resistance era.
We retrospectively cohort analysis who had Enterobacteriaceae bacteremia in neutropenic period after chemotherapy or stem cell transplantation at the one tertiary center from June 2009 to May 2013. We make comparison by ESBL producing, and empirical antibiotics (cefepime with isepamicin combination (below combination) versus carbapenem monotherapy). To adjust for non-random assignment of antibiotics, the propensity score method of inverse probability of treatment weighting and a multivariable analysis using Cox proportional hazards modeling were employed.
We identified total of 274 patients. Between ESBL group (n=97) and non ESBL group (n=177), baseline characteristics and clinical feature were not significant different. The 30-day mortality were not significantly different (10.6% vs 9.1%; p=0.659). Comparison by empirical antibiotics, Patients receiving carbapenem (n=30) were more likely to be clinically severe (high SAPS II Score, more presented as shock) and high proportion of ESBL producing (60.0% vs 32.%, p=0.005). Seven-day and 30-day mortality rate is significant high in carbapenem group (7-day : 16.7% vs 2.9%, log-rank test p=0.002. 30-day : 30.0% vs 7.8%, p<0.001). In a multivariable regression analysis combined with weights, 7-day survival rate were not differ significantly (p=0.756.), however 30-day mortality rate were high in carbapenem group (HR 2.24; 95% CI 1.21–4.15). In multivariate analysis of factor associated 30-day mortality, underlying hematologic disease status and initial clinically severity were independent predictive factor for 30-day mortality.
Carbapenem may not improve survival compared with combination of cefepime with isepamicin in Enterobacteriaceae bacteremia although ESBL production organism has increased.
J. K. Choi,
S. Y. Cho, None
S. H. Kim, None
H. J. Lee, None
S. M. Choi, None
S. H. Park, None
J. H. Choi, None
J. H. Yoo, None
See more of: Poster Abstract Session