Abstract
PurposeThe efficacy of prophylactic antimicrobial treatment renders challenges in patients with leukemias receiving chemotherapy. The study aimed to compare differences in C-reactive protein (CRP) and procalcitonin (PCT) at presentation and the immediate outcome measures of post-chemotherapy NF between patients with and without antimicrobial prophylaxis.MethodsA 5-year observational study included 282 NF episodes in 133 leukemia patients requiring hospital care from January 2014 to May 2019. We collected demographic characteristics, laboratory data of blood cell counts and inflammatory biomarkers, and immediate outcome measures of NF, including microbiologically diagnosed infections, presence of predominant pathogens, required modification of antibiotics during NF, adverse medical complications, total fever duration, and deaths. We evaluated data between patients with and without prophylaxis.ResultsOf patients, 77.3%, 68.4%, and 20.6% had antibiotic prophylaxis, antifungal prophylaxis, and no prophylaxis, respectively. There were totally 15 deaths—13 with antibiotic prophylaxis and 10 with antifungal prophylaxis. CRP, PCT, and immediate outcome measures of NF did not show significant differences between those with and without antimicrobial prophylaxis. Although between-group differences showed no statistical significance, higher median fever duration, CRP and PTC values, and higher proportions of NF requiring modification of antibiotics were found more frequently in those with antimicrobial prophylaxis than in those without.ConclusionThe benefits of using antimicrobial prophylaxis were less supported. Enhancing diagnostic laboratory and medical complication surveillance and periodic evaluation of institutional data during post-chemotherapy neutropenia and NF in relation to antimicrobial prophylaxis is promising in providing insights to redefine the risk–benefit accounts of using prophylaxis.
Highlights
Post-chemotherapy immunocompromised hematological patients are at risk of bacterial and fungal infections
Supportive Care in Cancer (2021) 29:7515–7523 antibiotic prophylaxis had a lower probability of response to first-line empirical antibiotic treatments and a delay in fever resolution compared with those randomized to no prophylaxis, and there was no reduction in hospital stays and cost among those receiving prophylaxis when compared to those without [7]
There is considerable literature showing that the emergence of antimicrobial resistance and the spread of multidrug-resistant pathogens are associated with the use of antibiotic prophylaxis [8,9,10,11]
Summary
Post-chemotherapy immunocompromised hematological patients are at risk of bacterial and fungal infections. Patients with hematological malignancies who developed neutropenic fever while on. There is considerable literature showing that the emergence of antimicrobial resistance and the spread of multidrug-resistant pathogens are associated with the use of antibiotic prophylaxis [8,9,10,11]. Investigators have even drawn attention to the fact that the potential benefit of prophylaxis in lowering the rate of infection was demonstrated in regions with low to moderate antibiotic resistance rates, suggesting that it might not be applicable in regions with a high prevalence of resistant pathogens [14,15,16]. A clear-cut benefit regarding the efficacy of antibiotic prophylaxis appears less assured
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
