PDF(Pubmed)
Abstract：
BACKGROUND: There is currently no consensus on optimal duration of antibiotic treatment in febrile neutropenia. We report on the clinical impact of implementation of antibiotic de-escalation and discontinuation strategies based on the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations in high-risk hematological patients.
METHODS: We studied 446 admissions after introduction of an ECIL-4-based protocol (hereafter \"ECIL-4 group\") in comparison to a historic cohort of 512 admissions. Primary clinical endpoints were the incidence of infectious complications including septic shock, infection-related intensive care unit (ICU) admission, and overall mortality. Secondary endpoints included the incidence of recurrent fever, bacteremia, and antibiotic consumption.
RESULTS: Bacteremia occurred more frequently in the ECIL-4 group (46.9% [209/446] vs 30.5% [156/512]; P < .001), without an associated increase in septic shock (4.7% [21/446] vs 4.5% [23/512]; P = .878) or infection-related ICU admission (4.9% [22/446] vs 4.1% [21/512]; P = .424). Overall mortality was significantly lower in the ECIL-4 group (0.7% [3/446] vs 2.7% [14/512]; P = .016), resulting mainly from a decrease in infection-related mortality (0.4% [2/446] vs 1.8% [9/512]; P = .058). Antibiotic consumption was significantly reduced by a median of 2 days on antibiotic therapy (12 vs 14; P = .001) and 7 daily antibiotic doses (17 vs 24; P < .001) per admission period.
CONCLUSIONS: Our results support implementation of ECIL-4 recommendations to be both safe and effective based on real-world data in a large high-risk patient population. We found no increase in infectious complications and total antibiotic exposure was significantly reduced.
METHODS: We studied 446 admissions after introduction of an ECIL-4-based protocol (hereafter \"ECIL-4 group\") in comparison to a historic cohort of 512 admissions. Primary clinical endpoints were the incidence of infectious complications including septic shock, infection-related intensive care unit (ICU) admission, and overall mortality. Secondary endpoints included the incidence of recurrent fever, bacteremia, and antibiotic consumption.
RESULTS: Bacteremia occurred more frequently in the ECIL-4 group (46.9% [209/446] vs 30.5% [156/512]; P < .001), without an associated increase in septic shock (4.7% [21/446] vs 4.5% [23/512]; P = .878) or infection-related ICU admission (4.9% [22/446] vs 4.1% [21/512]; P = .424). Overall mortality was significantly lower in the ECIL-4 group (0.7% [3/446] vs 2.7% [14/512]; P = .016), resulting mainly from a decrease in infection-related mortality (0.4% [2/446] vs 1.8% [9/512]; P = .058). Antibiotic consumption was significantly reduced by a median of 2 days on antibiotic therapy (12 vs 14; P = .001) and 7 daily antibiotic doses (17 vs 24; P < .001) per admission period.
CONCLUSIONS: Our results support implementation of ECIL-4 recommendations to be both safe and effective based on real-world data in a large high-risk patient population. We found no increase in infectious complications and total antibiotic exposure was significantly reduced.
摘要：
背景：目前关于抗生素治疗发热性中性粒细胞减少症的最佳持续时间尚无共识。我们报告了根据第四届欧洲白血病感染会议（ECIL-4）建议在高危血液病患者中实施抗生素降级和停药策略的临床影响。
方法：我们在引入基于ECIL-4的方案（以下简称“ECIL-4组”）后研究了446例入院，并与512例入院的历史队列进行了比较。主要临床终点是感染性并发症的发生率，包括感染性休克，感染相关重症监护病房（ICU）入院，和总死亡率。次要终点包括反复发热的发生率，菌血症,和抗生素消费。
结果：在ECIL-4组中，菌血症的发生率更高（46.9%[209/446]vs30.5%[156/512]；P<.001），感染性休克(4.7%[21/446]vs4.5%[23/512];P=.878)或感染相关ICU入院(4.9%[22/446]vs4.1%[21/512];P=.424)无相关增加。ECIL-4组的总死亡率显着降低（0.7％[3/446]比2.7％[14/512]；P=.016），主要是由于感染相关死亡率下降(0.4%[2/446]vs1.8%[9/512];P=.058)。每次入院期间，抗生素治疗的平均2天（12vs14;P=.001）和7日抗生素剂量（17vs24;P<.001）的抗生素消耗量显着减少。
结论：我们的结果支持ECIL-4建议的实施是安全和有效的，基于现实世界的数据在一个大的高风险患者群体。我们发现感染并发症没有增加，总的抗生素暴露量显著减少。
方法：我们在引入基于ECIL-4的方案（以下简称“ECIL-4组”）后研究了446例入院，并与512例入院的历史队列进行了比较。主要临床终点是感染性并发症的发生率，包括感染性休克，感染相关重症监护病房（ICU）入院，和总死亡率。次要终点包括反复发热的发生率，菌血症,和抗生素消费。
结果：在ECIL-4组中，菌血症的发生率更高（46.9%[209/446]vs30.5%[156/512]；P<.001），感染性休克(4.7%[21/446]vs4.5%[23/512];P=.878)或感染相关ICU入院(4.9%[22/446]vs4.1%[21/512];P=.424)无相关增加。ECIL-4组的总死亡率显着降低（0.7％[3/446]比2.7％[14/512]；P=.016），主要是由于感染相关死亡率下降(0.4%[2/446]vs1.8%[9/512];P=.058)。每次入院期间，抗生素治疗的平均2天（12vs14;P=.001）和7日抗生素剂量（17vs24;P<.001）的抗生素消耗量显着减少。
结论：我们的结果支持ECIL-4建议的实施是安全和有效的，基于现实世界的数据在一个大的高风险患者群体。我们发现感染并发症没有增加，总的抗生素暴露量显著减少。
