2687. Extended Infusions of Piperacillin/Tazobactam vs. Cefepime for Empiric Treatment of Neutropenic Fever

Abstract

BackgroundIn neutropenic patients, a fever may be the only indication of a severe underlying infection. According to the National Comprehensive Cancer Network (NCCN) guidelines, for high-risk patients, monotherapy with an anti-pseudomonal β-lactam agent should be initiated. NCCN states emerging data may support extended or continuous infusions of β-lactam therapies; however, preference is not given for cefepime or piperacillin/tazobactam. The objective of this study was to compare the outcomes of extended infusions of piperacillin/tazobactam vs. cefepime for the empiric treatment of neutropenic fever.MethodsThis retrospective, single-center cohort study included patients ≥18 years with an absolute neutrophil count (ANC) less than 500 cells/mm3, single oral temperature measurement ≥38.3°C or ≥38°C sustained over 1 hour period and admitted to a bone marrow transplant unit. Patients received extended infusion piperacillin/tazobactam or cefepime as initial antibiotic therapy for at least 48 hours between January 1, 2015 and September 1, 2018. The primary outcome was time to defervescence in hours. Secondary outcomes included time to defervescence and no acetaminophen use within 8 hours, defervescence by 72 hours, hospital length of stay, clinical failure, in-hospital mortality, and acute kidney injury.Results73 patients were included in this study (36 received piperacillin/tazobactam and 37 received cefepime). The primary outcome of median time to defervescence was 31.8 hours in the piperacillin/tazobactam group and 25 hours in the cefepime group (P = 0.26). Secondary outcomes in the piperacillin/tazobactam group compared with cefepime, respectively included median time to defervescence and no acetaminophen use: 43 vs. 35 hours (P = 0.16), defervescence by 72 hours: 66.7% vs. 91.9% (P = 0.01), median hospital length of stay 28 vs. 22 days (P = 0.04), clinical failure 22.2% vs. 24.3% (P = 0.83), in-hospital mortality 8.3% vs. 2.8% (P = 0.36), rate of acute kidney injury: 50% vs. 24.3% (P = 0.02).ConclusionThese findings suggest there is no difference in time to defervescence between extended infusions of piperacillin/tazobactam compared with extended infusions of cefepime for the empiric treatment of neutropenic fever.Disclosures All authors: No reported disclosures.