The outcome of non-carbapenem-based empirical antibacterial therapy and VRE colonisation in patients with hematological malignancies

H Gedik, T Yildirmak, F Simsek, A Kanturk, D Aydýn, D Anca, O Yokus, N Demirel

Abstract

Background: Febrile neutropenia (FN) is generally a complication of cancer chemotherapy.

Objective: We retrospectively evaluated the febrile neutropenia episodes and their outcomes with respect to modification rates of  non-carbapenem-based empirical antibacterial therapy and vancomycin-resistant enterococcus (VRE) colonisation that caused to VRE bacteremia in patients with hematological malignancies.

Methods: All consecutive patients, who were older than 14 years of age and developed febrile neutropenia episodes due to hematological  malignancies from September 2010 to November 2011 at the hematology department were included into the study.

Results: In total, 86 consecutive neutropenic patients and their 151 febrile episodes were evaluated. The mean MASCC prognostic index score was 18,72 ± 9,43. Among 86 patients, 28 patients experienced a total of 30 bacteremia episodes of bacterial origin. Modification rates of both, empirical monotherapy and combination therapies, were found similar, statistically (P =0,840).

Conclusion: Our results suggest that initiating of non-carbapenem based therapy does not provide high response rates in the treatment of febrile neutropenia attacks. Furthermore, non-carbapenem-based empirical therapy provides benefit in regard to cost-effectiveness and antimicrobial stewardship when local antibiotic resistance patterns of gram-negative bacteria are considered. Patients who are colonized with VRE are more likely to develop bacteremia with VRE strains as a result of invasive procedures and severe damage of mucosal barriers observed in this group of patients.

Keywords: Hematological malignancy, febrile neutropenia, bacteremia, VRE, colonisation, ESBL, gram-negative bacteria