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<p>In febrile neutropenia (FN), when 72-hour cultures are sterile, early de-escalation of broad-spectrum antibiotics is recommended, to reduce the risk of developing multidrug resistance (MDR). However, due to lack of supportive evidence in MDR endemic areas, clinicians often hesitate to de-escalate antibiotics, fearing negative outcomes. We reviewed the charts of FN patients on empirical Meropenem monotherapy who showed improvement in quick Sequential Organ Failure Assessment (qSOFA) scores and had sterile cultures at 72&#xa0;h and categorized them into Meropenem de-escalated (MD) and Meropenem continued (MC) groups. Outcomes were compared between the two groups based on improvement in qSOFA score at day 7, 30-day all-cause mortality, Duration of hospitalization, fever recurrence, reduction in procalcitonin levels, re-hospitalizations within 6 months, and reinfections within 30 days. Of a total of 88 patients, Meropenem was de-escalated in 74 and continued in 14 patients. De-escalation was found to be non-inferior to continuation (<i>p</i> &lt; 0.001) based on improvement in qSOFA scores. Neither group had any 30-day mortalities. The outcomes were comparable with respect to duration of hospitalization, fever recurrence, reduction in procalcitonin levels, and re-hospitalizations. The reinfection rates were higher in the MD group. But the fraction of MDR infections was much lower (24.32%) in the MD group compared to the MC group (100%). In clinically stable patients with no documented infections, de-escalation after 72&#xa0;h may be a reasonable approach, even in settings with a high prevalence of MDR infections to reduce the development of MDR infections.</p>

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A Cohort Study on the Early De-Escalation of Empirical Meropenem in Febrile Neutropenia with a High Prevalence of MDR Infections

  • 期刊论文

  • 发表日期：

    2025年9月20日

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  • Maridas Tom Thomas,
  • Geethalakshmi Velayudhan,
  • Aleena Issac,
  • Colleen Mallier,
  • Shaheen Salavudheen,
  • Sreeraj Vasudevan,
  • Gopika Mohan,
  • Donna Liza Thampan,
  • Sharon Mathew,
  • Ramankutty,
  • Anil Jose Thazhath

摘要

In febrile neutropenia (FN), when 72-hour cultures are sterile, early de-escalation of broad-spectrum antibiotics is recommended, to reduce the risk of developing multidrug resistance (MDR). However, due to lack of supportive evidence in MDR endemic areas, clinicians often hesitate to de-escalate antibiotics, fearing negative outcomes. We reviewed the charts of FN patients on empirical Meropenem monotherapy who showed improvement in quick Sequential Organ Failure Assessment (qSOFA) scores and had sterile cultures at 72 h and categorized them into Meropenem de-escalated (MD) and Meropenem continued (MC) groups. Outcomes were compared between the two groups based on improvement in qSOFA score at day 7, 30-day all-cause mortality, Duration of hospitalization, fever recurrence, reduction in procalcitonin levels, re-hospitalizations within 6 months, and reinfections within 30 days. Of a total of 88 patients, Meropenem was de-escalated in 74 and continued in 14 patients. De-escalation was found to be non-inferior to continuation (p < 0.001) based on improvement in qSOFA scores. Neither group had any 30-day mortalities. The outcomes were comparable with respect to duration of hospitalization, fever recurrence, reduction in procalcitonin levels, and re-hospitalizations. The reinfection rates were higher in the MD group. But the fraction of MDR infections was much lower (24.32%) in the MD group compared to the MC group (100%). In clinically stable patients with no documented infections, de-escalation after 72 h may be a reasonable approach, even in settings with a high prevalence of MDR infections to reduce the development of MDR infections.