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Early Antibiotic Deescalation and Discontinuation in Patients with Febrile Neutropenia after Cellular Therapy: A Single-Center Prospective Unblinded Randomized Trial.
Ram, Ron; Amit, Odelia; Adler, Amos; Bar-On, Yael; Beyar-Katz, Ofrat; Avivi, Irit; Shasha, David; Ben-Ami, Ronen.
Afiliación
  • Ram R; Bone Marrow Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: ronr@tlvmc.gov.il.
  • Amit O; Bone Marrow Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Adler A; Infection Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Bar-On Y; Bone Marrow Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Beyar-Katz O; Bone Marrow Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Avivi I; Bone Marrow Transplantation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Shasha D; Infection Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Ben-Ami R; Infection Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel.
Transplant Cell Ther ; 29(11): 708.e1-708.e8, 2023 Nov.
Article en En | MEDLINE | ID: mdl-37591446
The optimal duration of empiric antimicrobial therapy of febrile neutropenia in patients after cellular therapy is unclear. Early deescalation has been suggested by some authorities; however, data are lacking for cellular therapy recipients. We performed a randomized controlled study of cellular therapy recipients with febrile neutropenia to evaluate the safety and noninferiority of an early deescalation and discontinuation antibiotic strategy (EDD arm) versus standard broad-spectrum antibiotic treatment until recovery of neutropenia (standard duration arm). The primary outcome was the fraction of antibiotic-free neutropenia days. We randomized 110 patients to the standard duration arm (n = 51) or EDD arm (n = 59). The fraction of antibiotic-free neutropenia days was higher in the EDD arm compared to the standard duration arm (median, .8 [interquartile range (IQR), .62 to .86] versus .51 [IQR, .17 to .86]; P = .016). This was true for the per-protocol, allogeneic hematopoietic cell transplantation (HCT), autologous HCT, and anti-CD19 chimeric antigen receptor T cell therapy subgroups. Treatment success rate, subsequent fever, death within 30 days, and other common cellular therapy-related toxicities were all similar between the 2 study arms. An EDD antibiotic strategy in patients after cellular therapy was safe and associated with a substantial reduction in broad-spectrum antibiotic utilization without compromising cellular therapy outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neutropenia Febril / Antiinfecciosos Tipo de estudio: Clinical_trials / Guideline / Risk_factors_studies Límite: Humans Idioma: En Revista: Transplant Cell Ther Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neutropenia Febril / Antiinfecciosos Tipo de estudio: Clinical_trials / Guideline / Risk_factors_studies Límite: Humans Idioma: En Revista: Transplant Cell Ther Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos