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