Meropenem administration results in a better clinical outcome for febrile neutropenia episodes

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“Meropenem administration in EI results in a better clinical outcome for febrile neutropenia episodes, with fewer additional antibiotics needed.” Fehér et al (2014).

Reference:

Fehér, C., Rovira, M., Soriano, A., Esteve, J., Martínez, J.E., Marco, F., Carreras, E., Martínez, C., Fernández-Avilés, F., Suárez-Lledó, M. and Mensa, J. (2014) Effect of meropenem administration in extended infusion on the clinical outcome of febrile neutropenia: a retrospective observational study. Journal of Antimicrobial Chemotherapy. 69(9), p.2556-2562.

Abstract:

Objectives: Information on the efficacy of extended meropenem administration in neutropenic patients is scarce. Our objective was to determine whether the administration of meropenem in a 4 h extended infusion (EI) leads to a better clinical outcome in patients with febrile neutropenia than the conventional short infusion (SI).

Methods: This was a retrospective observational study. The subjects were neutropenic patients who presented with fever after receiving haematopoietic stem-cell transplantation or induction chemotherapy for acute myeloid leukaemia. The primary endpoint was the success of treatment after 5 days of meropenem therapy, defined as follows: the disappearance of fever leading to a maintained (≥24 h) feverless state; the resolution or improvement of the clinical signs and symptoms of infection; the absence of persistent or breakthrough bacteraemia; and no additional antibiotics prescribed because of an unsatisfactory clinical evolution.

Results: Eighty-eight patients received meropenem (1 g/8 h) in SI and 76 received the same dose in EI. Treatment success on day 5 was superior in the EI group [52/76 (68.4%) versus 36/88 (40.9%); P < 0.001]. Meropenem administered in EI was independently associated with success (OR 3.13, 95% CI 1.61–6.10). Fewer additional antibiotics were prescribed in the EI group during the first 5 days of treatment [20/76 (26.3%) versus 44/88 (50.0%); P = 0.002]. Using Kaplan–Meier survival analysis a more prompt defervescence and a faster decrease in C-reactive protein concentration were observed in the EI group (P = 0.021 and P = 0.037, respectively). There were no significant differences in the length of hospital stay and in the mortality rate.

Conclusions: Meropenem administration in EI results in a better clinical outcome for febrile neutropenia episodes, with fewer additional antibiotics needed.

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