Main Article Content

Cumali Yalçın https://orcid.org/0000-0002-5129-2977
Fahir Özkalemkaş
Vildan Özkocaman
Tuba Ersal
İbrahim Ethem Pınar
Bedrettin Orhan
Ömer Candar
Sinem Çubukçu
Tuba Güllü Koca
Merve Nur Akyol
Nevriye Gül Ada
Cüneyt Özakın
Esra Kazak
Halis Akalın
Rıdvan Ali


Empiric glycopeptide, Febrile neutropenia, Hematologic malignancy


Background: This study aimed to evaluate the effects of the appropriate use of empiric glycopeptide therapy in hematologic malignancy patients with febrile neutropenia (FN).

Materials and Methods: Patients with FN who were hospitalized in our clinic and started empiric glycopeptide therapy were retrospectively analyzed. Empiric glycopeptide treatment initial indications were determined according to 7 specific criteria in the IDSA guidelines. In addition, the duration of glycopeptide use according to initial indications, causative pathogens in culture positivity, frequency of VRE infection, and the mortality rate was identified.

Results: 87 patients were included. Of these, 102 episodes of FN were analyzed. Appropriate use of glycopeptides was observed in 98% of patients. The most common initial indication for glycopeptide was skin or soft-tissue infection, with 52% (n = 53). The mean duration of glycopeptide use was 11 (2–22) days. The duration of glycopeptide use was longer in patients with catheter-related infections than in those with severe mucositis and hemodynamic instability (p = 0,041/p = 0,016). The duration of glycopeptide use was shorter in patients with consolidation therapy than those without consolidation therapy. The mortality rate in culture-positive patients was significantly higher than in those who were culture-negative (p = 0.041). When the patients who were culture-positive and culture-negative were compared, there was no significant difference in the duration of glycopeptide use.

Conclusion: This study showed that the mortality rate was higher in culture-positive patients. Additionally, the use of glycopeptides should be discontinued early with no evidence of gram-positive infection.



Download data is not yet available.
Abstract 61 | PDF Downloads 15 HTML Downloads 5


1. Klastersky J. Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis. 2004;39 Suppl 1:32–37. https://doi.org/10.1086/383050
2. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106:2258–2266. https://doi.org/10.1002/cncr.21847
3. Virizuela JA, Carratalà J, Aguado JM, Vicente D, Salavert M, Ruiz M, Ruiz I, Marco F, Lizasoain M, Jiménez-Fonseca P, Gudiol C, Cassinello J, Carmona-Bayonas A, Aguilar M, Cruz JJ. Management of infection and febrile neutropenia in patients with solid cancer. Clin Transl Oncol. 2016;18:557-570. https://doi.org/10.1007/s12094-015-1442-4 PMid:26577106
4. Wisplinghoff H, Seifert H, Wenzel RP. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis. 2003;36:1103–1110. https://doi.org/10.1086/374339
5. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52:56-93. https://doi.org/10.1093/cid/cir073
6. Baden LR, Swaminathan S, Angarone M Blouin G, Camins BC, Casper C, Cooper B, Dubberke ER, Engemann AM, Freifeld AG, Greene JN, Ito JI, Kaul DR, Lustberg ME, Montoya JG, Rolston K, Satyanarayana G, Segal B, Seo SK, Shoham S, Taplitz R, Topal J, Wilson JW, Hoffmann KG, Smith C. Prevention and Treatment of Cancer-Related Infections, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14:882-913. https://doi.org/10.6004/jnccn.2016.0093
PMid: 27407129
7. Paul M, Borok S, Fraser A, Vidal L, Leibovici L. Empirical antibiotics against gram positive infections for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2005;55:436–444. https://doi.org/10.1093/jac/dki028
8. Libuit J, Whiteman A, Wolfe R, Washington CS. Empiric vancomycin use in febrile neutropenic oncology patients. Open Forum Infect Dis. 2014;1:1–3. https://doi.org/10.1093/ofid/ofu006
9. Wright JD, Neugut AI, Ananth CV, Lewin SN, Wilde ET, Lu YS, Herzog TJ, Hershman DL Deviations from guideline-based therapy for febrile neutropenia in cancer patients and their effect on outcomes. JAMA Intern Med. 2013;173:559–568. https://doi.org/10.1001/jamainternmed.2013.2921
10. Cruciani M, Rampazzo R, Malena M, Lazzarini L, Todeschini G, Messori A, Concia E. Prophylaxis with fluoroquinolones for bacterial infections in neutropenic patients: a meta-analysis. Clin Infect Dis. 1996;23:795–805. https://doi.org/10.1093/clinids/23.4.795
11. Bradley AM, Deal AM, Buie LW, van Deventer H. Neutropenia-associated outcomes in adults with acute myeloid leukemia receiving cytarabine consolidation chemotherapy with or without granulocyte colony-stimulating factor. Pharmacotherapy. 2012;32:1070-1077. https://doi.org/10.1002/phar.1150
12. Khan HA, Ahmad A, Mehboob R. Nosocomial infections and their control strategies. Asian Pac J Trop Biomed. 2015;7:509-514. https://doi.org/10.1016/j.apjtb.2015.05.001
13. Ford CD, Lopansri BK, Haydoura S, Snow G, Dascomb KK, Asch J, BoPetersen F, Burke JP. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia. Infect Control Hosp Epidemiol. 2015;36:47-53. https://doi.org/10.1017/ice.2014.3 PMid:25627761
14. Kirkizlar TA, Akalin H, Kirkizlar O, Ozkalemkas F, Ozkocaman V, Kazak E, Ozakin C, Bulbul EN, Ozboz ES, Ali R. Vancomycin-resistant enterococci infection and predisposing factors for infection and mortality in patients with acute leukaemia and febrile neutropenia. Leuk Res. 2020;99:106463.
15. Heisel RW, Sutton RR, Mascara GP, Winger DG, Weber DR, Lim SH, Oleksiuk LM. Vancomycin-resistant enterococci in acute myeloid leukemia and myelodisplastic syndrome patients undergoing induction chemotherapy with idarubicin and cytarabine, Leuk. Lymphoma. 2017;58:2565–2572.
16. Ban T, Fujiwara SI, Murahashi R, Nakajima H, Ikeda T, Matsuoka S, Toda Y, Kawaguchi SI, Ito S, Nagayama T, Umino K, Minakata D, Nakano H, Morita K, Ashizawa M, Yamamoto C, Hatano K, Sato K, Ohmine K, Kanda Y. Risk Factors for Complications Associated with Peripherally Inserted Central Catheters During Induction Chemotherapy for Acute Myeloid Leukemia. Intern Med. 2021;8184-8121.
17. Mollee P, Jones M, Stackelroth J, van Kuilenburg R, Joubert W, Faoagali J, Looke D, Harper J, Clements A. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect. 2021;78:26-30. https://doi.org/10.1016/j.jhin.2011.01.018
18. Ghanem GA, Boktour M, Warneke C, Pham-Williams T, Kassis C, Bahna P, Aboufaycal H, Hachem R, Raad I. Catheter-related Staphylococcus aureus bacteremia in cancer patients: high rate of complications with therapeutic implications. Medicine (Baltimore) 2007;86:54-60. https://doi.org/10.1097/MD.0b013e318030d344 PMid:17220756
19. Pathak R, Giri S, Aryal MR, Karmacharya P, Bhatt VR, Martin MG. Mortality, length of stay, and health care costs of febrile neutropenia-related hospitalizations among patients with breast cancer in the United States. Support Care Cancer. 2015;23:615–617. https://doi.org/10.1007/s00520-014-2553-0
20. Caggiano V, Weiss RV, Rickert TS, Linde-Zwirble WT. Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy. Cancer. 2005;103: 1916–1924. https://doi.org/10.1002/cncr.20983
21. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106: 2258-2266. https://doi.org/10.1002/cncr.21847
22. Morris PG, Hassan T, McNamara M, Hassan A, Wiig R, Grogan L, Breathnach OS, Smyth E, Humphreys H. Emergence of MRSA in positive blood cultures from patients with febrile neutropenia--a cause for concern. Support Care Cancer. 2008;16:1085-1088. https://doi.org/10.1007/s00520-007-0398-5
23. Mert D, Ceken S, Iskender G, Iskender D, Merdin A, Duygu F, Ertek M, Altuntas F. Epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies. J Infect Dev Ctries. 2019;13:727-735.
24. Özdemir SK, Iltar U, Salim O, Yücel OK, Erdem R, Turhan Ö, Undar L. Investigation of seasonal frequency and pathogens in febrile neutropenia. Memo. 2019; 12:119-122. https://doi.org/10.3855/jidc.11457
25. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the infectious diseases societyof America. Clin Infect Dis. 2009;49: 1–45.

Most read articles by the same author(s)