Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0208039
Title: Impact of an alternating first-line antibiotics strategy in febrile neutropenia
Authors: Tan B.H. 
Torres De Guzman M.R.
Sioco Donato L.K.
Kalimuddin S. 
Lee W.H.L.
Tan A.L.
Wong G.C. 
Keywords: amikacin
antibiotic agent
aztreonam
carbapenem derivative
cefepime
ciprofloxacin
daptomycin
gentamicin
gentamicin C
linezolid
meropenem
piperacillin plus tazobactam
vancomycin
antiinfective agent
adolescent
adult
aged
all cause mortality
Antibiotic Heterogeneity Index
antibiotic therapy
Article
bacteremia
carbapenem-resistant Enterobacteriaceae
child
dispersity
febrile neutropenia
female
hospital admission
human
major clinical study
male
methicillin resistant Staphylococcus aureus
vancomycin resistant Enterococcus
antibiotic resistance
bacteremia
clinical practice
complication
febrile neutropenia
hematologic disease
middle aged
mortality
treatment outcome
very elderly
young adult
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Bacteremia
Child
Drug Resistance, Bacterial
Febrile Neutropenia
Female
Hematologic Neoplasms
Humans
Male
Middle Aged
Practice Patterns, Physicians'
Treatment Outcome
Young Adult
Issue Date: 2018
Citation: Tan B.H., Torres De Guzman M.R., Sioco Donato L.K., Kalimuddin S., Lee W.H.L., Tan A.L., Wong G.C. (2018). Impact of an alternating first-line antibiotics strategy in febrile neutropenia. PLoS ONE 13 (11) : e0208039. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0208039
Abstract: Background Rising antibiotic resistance poses a challenge to the management of febrile neutropenia in patients with haematological malignancies receiving chemotherapy. Aim We studied an alternating first-line antibiotic strategy to determine its impact on all-cause mortality and bacteremia rates in patients with febrile neutropenia. Methods 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. Findings 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. Conclusion 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. © 2018 Tan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161207
ISSN: 19326203
DOI: 10.1371/journal.pone.0208039
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