Impact of an alternating first-line antibiotics strategy in febrile neutropenia.
<h4>Background</h4>Rising antibiotic resistance poses a challenge to the management of febrile neutropenia in patients with haematological malignancies receiving chemotherapy.<h4>Aim</h4>We studied an alternating first-line antibiotic strategy to determine its impact on all-c...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0208039 |
| _version_ | 1828953318333874176 |
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| author | Ban Hock Tan Marvin Raden Torres De Guzman Lara Kristina Sioco Donato Shirin Kalimuddin Winnie Hui Ling Lee Ai Ling Tan Gee Chuan Wong |
| author_facet | Ban Hock Tan Marvin Raden Torres De Guzman Lara Kristina Sioco Donato Shirin Kalimuddin Winnie Hui Ling Lee Ai Ling Tan Gee Chuan Wong |
| author_sort | Ban Hock Tan |
| collection | DOAJ |
| description | <h4>Background</h4>Rising antibiotic resistance poses a challenge to the management of febrile neutropenia in patients with haematological malignancies receiving chemotherapy.<h4>Aim</h4>We studied an alternating first-line antibiotic strategy to determine its impact on all-cause mortality and bacteremia rates in patients with febrile neutropenia.<h4>Methods</h4>An alternating first-line antibiotic strategy was established in mid-2013. Data for 2012 (before strategy implementation) and 2014 (post-strategy implementation) were compared. Antibiotic Heterogeneity Index (AHI) for each of the two time-periods was also calculated.<h4>Findings</h4>There were 2012 admissions (26082 patient-days) in 2012 and 1843 admissions (24331 patient-days) in 2014. There was no significant difference in the baseline characteristics of patients in the two groups. The defined daily doses (DDD) of cefepime (CEF) fell while the DDD of piperacillin-tazobactam (PTZ) rose in 2014 compared with 2012. Vancomycin DDD fell in 2014. The AHI was 0.466 in 2012 and 0.582 in 2014. The difference in all-cause mortality was not statistically significant. There was no difference in rates of bacteremia with CEF-resistant, PTZ-resistant and carbapenem-resistant gram-negative organisms in the two groups. Rates of new cases of Methicillin-resistant Staphylococcus aureus (MRSA) were 2.38/1000 and 2.59/1000 patient-days in 2012 and 2014 respectively. Rates of new cases of Vancomycin-resistant Enterococcus (VRE) were 1.84/1000 and 1.81/1000 patient-days in 2012 and 2014 respectively. There was no Carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in 2012 and 1 in 2014.<h4>Conclusion</h4>An alternating first-line antibiotic strategy resulted in an increase in antibiotic heterogeneity, without increasing mortality. There was also no significant increase in bacteremia rates. |
| first_indexed | 2024-12-14T07:08:43Z |
| format | Article |
| id | doaj.art-218b9d2850594530a3ab34e76cf5839b |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-14T07:08:43Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-218b9d2850594530a3ab34e76cf5839b2022-12-21T23:12:03ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-011311e020803910.1371/journal.pone.0208039Impact of an alternating first-line antibiotics strategy in febrile neutropenia.Ban Hock TanMarvin Raden Torres De GuzmanLara Kristina Sioco DonatoShirin KalimuddinWinnie Hui Ling LeeAi Ling TanGee Chuan Wong<h4>Background</h4>Rising antibiotic resistance poses a challenge to the management of febrile neutropenia in patients with haematological malignancies receiving chemotherapy.<h4>Aim</h4>We studied an alternating first-line antibiotic strategy to determine its impact on all-cause mortality and bacteremia rates in patients with febrile neutropenia.<h4>Methods</h4>An alternating first-line antibiotic strategy was established in mid-2013. Data for 2012 (before strategy implementation) and 2014 (post-strategy implementation) were compared. Antibiotic Heterogeneity Index (AHI) for each of the two time-periods was also calculated.<h4>Findings</h4>There were 2012 admissions (26082 patient-days) in 2012 and 1843 admissions (24331 patient-days) in 2014. There was no significant difference in the baseline characteristics of patients in the two groups. The defined daily doses (DDD) of cefepime (CEF) fell while the DDD of piperacillin-tazobactam (PTZ) rose in 2014 compared with 2012. Vancomycin DDD fell in 2014. The AHI was 0.466 in 2012 and 0.582 in 2014. The difference in all-cause mortality was not statistically significant. There was no difference in rates of bacteremia with CEF-resistant, PTZ-resistant and carbapenem-resistant gram-negative organisms in the two groups. Rates of new cases of Methicillin-resistant Staphylococcus aureus (MRSA) were 2.38/1000 and 2.59/1000 patient-days in 2012 and 2014 respectively. Rates of new cases of Vancomycin-resistant Enterococcus (VRE) were 1.84/1000 and 1.81/1000 patient-days in 2012 and 2014 respectively. There was no Carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in 2012 and 1 in 2014.<h4>Conclusion</h4>An alternating first-line antibiotic strategy resulted in an increase in antibiotic heterogeneity, without increasing mortality. There was also no significant increase in bacteremia rates.https://doi.org/10.1371/journal.pone.0208039 |
| spellingShingle | Ban Hock Tan Marvin Raden Torres De Guzman Lara Kristina Sioco Donato Shirin Kalimuddin Winnie Hui Ling Lee Ai Ling Tan Gee Chuan Wong Impact of an alternating first-line antibiotics strategy in febrile neutropenia. PLoS ONE |
| title | Impact of an alternating first-line antibiotics strategy in febrile neutropenia. |
| title_full | Impact of an alternating first-line antibiotics strategy in febrile neutropenia. |
| title_fullStr | Impact of an alternating first-line antibiotics strategy in febrile neutropenia. |
| title_full_unstemmed | Impact of an alternating first-line antibiotics strategy in febrile neutropenia. |
| title_short | Impact of an alternating first-line antibiotics strategy in febrile neutropenia. |
| title_sort | impact of an alternating first line antibiotics strategy in febrile neutropenia |
| url | https://doi.org/10.1371/journal.pone.0208039 |
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