COMPARISON OF EMPIRIC ANTIBIOTIC ESCALATION THERAPY WITH VANCOMYCIN (VAN) VERSUS LINEZOLID (LIN) IN PATIENTS WITH FEBRILE NEUTROPENIA
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Keywords
Neutropenic fever, antibiotic escalation, bacteria, infection
Abstract
Background:
In febrile neutropenia linezolid (LIN) and also vancomycin (VAN) can be used if a gram-positive infection is suspected. Interestingly there is no literature in which both are compared in the setting of febrile neutropenia. Therefore we provide here the results of a retrospective analysis of adding VAN versus LIN in patients with febrile neutropenia.
Methods:
Patients with haematological diseases and febrile neutropenia after myelosuppressive chemotherapy and no clearance of infection after the first empiric broad spectrum antibiotic, which were escalated to VAN or LIN from 03/2010 to 03/2014 at the University Hospital Bonn were included in this retrospective analysis.
Results:
Out of the 73 patients 50 had received VAN and 23 LIN. The median time of hospitalisation in the LIN cohort was significant shorter than in the VAN cohort (LIN 16 days vs VAN 20 days p=0.046). Successful defervescence with the escalation to VAN or LIN could be detected in 76% of the LIN cases and 50% in the VAN group (p=0.052). This trend to a better efficacy with LIN was also shown by a higher rate of discontinuation of VAN and escalation to another antibiotic scheme (54.2%) than in the LIN cohort (24%, p=0.052).
Conclusion:
The antibiotic therapy in febrile neutropenia with LIN showed a trend to a better efficacy than therapy with VAN. But because of the small sample size and the retrospective manner VAN may still be considered a reasonable option in neutropenic fever and randomized studies are needed in this field.
KEYWORDS: GRAM+ INFECTIONS, VANCOMYCIN, LINEZOLID, DOSE ESCALATION.
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References
1. Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C (2011) 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours, vol 1, England
2. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young J-AH, Wingard JR (2011) 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 52(4): 427–431. https://doi.org/10.1093/cid/ciq147
3. Maschmeyer G, Carratala J, Buchheidt D, Hamprecht A, Heussel CP, Kahl C, Lorenz J, Neumann S, Rieger C, Ruhnke M, Salwender H, Schmidt-Hieber M, Azoulay E (2015) Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 26(1): 21–33. https://doi.org/10.1093/annonc/mdu192
4. Bow EJ (2011) Fluoroquinolones, antimicrobial resistance and neutropenic cancer patients. Curr Opin Infect Dis 24(6): 545–553. https://doi.org/10.1097/QCO.0b013e32834cf054
5. Klastersky J, Aoun M (2004) Opportunistic infections in patients with cancer. Ann Oncol 15 Suppl 4: iv329-35. https://doi.org/10.1093/annonc/mdh947
6. Gustinetti G, Mikulska M (2016) Bloodstream infections in neutropenic cancer patients: A practical update. Virulence 7(3): 280–297. https://doi.org/10.1080/21505594.2016.1156821
7. Klastersky J (2004) Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis 39 Suppl 1: S32-7. https://doi.org/10.1086/383050
8. Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, Akova M (2013) European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 98(12): 1826–1835. https://doi.org/10.3324/haematol.2013.091025
9. Schwab KS, Hahn-Ast C, Heinz WJ, Germing U, Egerer G, Glasmacher A, Leyendecker C, Marklein G, Nellessen CM, Brossart P, Lilienfeld-Toal M von (2014) Tigecycline in febrile neutropenic patients with haematological malignancies: a retrospective case documentation in four university hospitals. Infection 42(1): 97–104. https://doi.org/10.1007/s15010-013-0524-x
10. Jaksic B, Martinelli G, Perez-Oteyza J, Hartman CS, Leonard LB, Tack KJ (2006) Efficacy and safety of linezolid compared with vancomycin in a randomized, double-blind study of febrile neutropenic patients with cancer. Clin Infect Dis 42(5): 597–607. https://doi.org/10.1086/500139
11. Kohno S, Yamaguchi K, Aikawa N, Sumiyama Y, Odagiri S, Aoki N, Niki Y, Watanabe S, Furue M, Ito T, Croos-Dabrera R, Tack KJ (2007) Linezolid versus vancomycin for the treatment of infections caused by methicillin-resistant Staphylococcus aureus in Japan. J Antimicrob Chemother 60(6): 1361–1369. https://doi.org/10.1093/jac/dkm369
12. Falagas ME, Siempos II, Vardakas KZ (2008) Linezolid versus glycopeptide or beta-lactam for treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials. Lancet Infect Dis 8(1): 53–66. https://doi.org/10.1016/S1473-3099(07)70312-2
13. Yue J, Dong BR, Yang M, Chen X, Wu T, Liu GJ (2016) Linezolid versus vancomycin for skin and soft tissue infections, vol 1, England
14. Lakhani N, Thompson W, Bombassaro AM (2005) Probable linezolid-induced pancytopenia. Can J Infect Dis Med Microbiol 16(5): 286–288
15. Nedved AN, DeFrates SR, Hladnik LM, Stockerl-Goldstein KE (2016) Effect of Linezolid on Hematologic Recovery in Newly Diagnosed Acute Myeloid Leukemia Patients Following Induction Chemotherapy. Pharmacotherapy 36(10): 1087–1094. https://doi.org/10.1002/phar.1824
16. Pritchard L, Baker C, Leggett J, Sehdev P, Brown A, Bayley KB (2010) Increasing vancomycin serum trough concentrations and incidence of nephrotoxicity. Am J Med 123(12): 1143–1149. https://doi.org/10.1016/j.amjmed.2010.07.025
17. Patel DA, Michel A, Stephens J, Weber B, Petrik C, Charbonneau C (2014) An economic model to compare linezolid and vancomycin for the treatment of confirmed methicillin-resistant Staphylococcus aureus nosocomial pneumonia in Germany. Infect Drug Resist 7: 273–280. https://doi.org/10.2147/IDR.S68658
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