2401. Patterns of Linezolid and Daptomycin Use in Leukemia Patients with Neutropenic Fever Presenting to the Emergency Center
Session: Poster Abstract Session: Transplantation - Prophylaxis and Prediction
Saturday, October 7, 2017
Room: Poster Hall CD
Background: Concerns for resistant Gram positive bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, have led to increased use of daptomycin (DAP) and linezolid (LZD) in leukemia patients with neutropenic fever (NF). Correspondingly, resistance to these agents has increased. We sought to characterize the patterns of use of these agents in leukemia patients with NF to identify those who might benefit from antimicrobial stewardship efforts.

Methods: This was a retrospective review of patients with leukemia and NF (absolute neutrophil count [ANC] <500 cells/mm3; temperature ≥38.3°C) who presented to the emergency center (EC) at MD Anderson Cancer Center from January 2014 to December 2015. We assessed the use of LZD and DAP as it related to the presence of a defined infectious syndrome. Five clinical syndromes (pneumonia, skin/soft tissue infection, sinusitis, urinary tract infection, intra-abdominal infection), based on definitions in the NF literature, were included. Outcomes were the number of patients receiving DAP or LZD within 24 hours of presentation and the duration of therapy for these agents.

Results: A total of 232 patients (mean age 56 ± 17 years; 61% male) presented to the EC 327 times. The majority had acute myeloid leukemia (n=165, 71%) and 50% had relapsed disease. 84% had neutropenia >7 days in duration and the median ANC at presentation was 0 cells/mm3 (range: 0 - 490). Overall, 31% had a defined infectious syndrome. Eighty percent of patients received DAP or LZD within 24 hours of presentation (LZD: 75%; DAP: 6%). Patients with or without an infectious syndrome were equally likely to receive LZD (77% vs 74%, p = 0.60) while DAP use was significantly more common in patients with an infectious syndrome (10% vs 4%, p = 0.02). Duration of LZD use was significantly longer in patients with an infectious syndrome (median 4 vs 3 days, p = 0.02), with no difference seen in patients receiving DAP (p= 0.82).

Conclusion: The majority of patients with leukemia at MDACC presenting to the EC with NF receive LZD or DAP. The presence of infectious syndromes correlated poorly with LZD use, while DAP appeared to be used in a more targeted manner. Focused antimicrobial stewardship efforts are needed to limit inappropriate antibiotic use in these vulnerable patients.

Samuel L. Aitken, PharmD1,2, Deeksha Jandhyala, M.D.3,4, Victor E. Mulanovich, MD4, Kayleigh R. Marx, PharmD2, Frank P. Tverdek, PharmD2, Roy F. Chemaly, MD, MPH, FIDSA, FACP5, Kenneth V. I. Rolston, MD4 and Samuel A. Shelburne, MD, PhD4, (1)Center for Antimicrobial Resistance and Microbial Genomics (CARMiG), UTHealth McGovern Medical School, Houston, TX, (2)Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)Division of Infectious Diseases, University of Texas Health Science Center at Houston, Houston, TX, (4)Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (5)University of Texas M.D. Anderson Cancer Center, Houston, TX

Disclosures:

S. L. Aitken, None

D. Jandhyala, None

V. E. Mulanovich, None

K. R. Marx, None

F. P. Tverdek, None

R. F. Chemaly, Merck & Co., Inc.: Consultant and Investigator , Consulting fee , Research grant and Speaker honorarium

K. V. I. Rolston, None

S. A. Shelburne, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.