Primary Prophylaxis with Piperacillin/Tazobactam in Lymphoma Patients Managed at Home after Autologous Stem Cell Transplantation

Abstract

Background: Neutropenic fever (NF) is the most frequent cause of hospital readmission in ambulatory care programs for patients treated with autologous stem cell transplantation (ASCT). Methods: Analyze the impact of intensifying primary antibiotic prophylaxis with piperacillin/tazobactam (PT) in the incidence of NF and in the need for hospital readmission in a home care ASCT model. Between January 2002 and June 2017, 143 consecutive lymphoma patients, conditioned with BEAM, were managed at home since +1day of ASCT. Sixty-one patients (42*7%) received prophylactic ceftriaxone (Ct) and 82 (57*3%) PT. Due to the presence of differences in the baseline characteristics, we performed a propensity score matching. The final study population was 86 patients (43 in each group). Findings: NF occurred in 39*5% of patients in the prophylactic PT group compared with 86% in Ct group (P<0*0001). Blood culture positive was documented in 11*8% and 18*9% febrile episodes in the PT and Ct group, respectively; being coagulase-negative Staphylococcus the most frequently isolated bacteria in Ct group. In the multivariate analysis, PT retained its independent protective factor for NF (OR 0*11; P<0*001). Hospital readmission was required in 6 (14%) patients in the Ct group and 1 (2*3%) patient in the PT group (P=0*1). In the multivariate analysis, only PT retained its independent protective factor for hospital readmission (OR 0*11; P=0*05). Interpretation: This study suggests that in at home ASCT, the use of PT prophylaxis significantly reduces the incidence of NF in lymphoma patients. Funding: The authors do not have any funding sources. Declaration of Interest: The authors declare no disclosures. Ethical Approval: The Ethics Committee of the Hospital Clinic of Barcelona approved the study and was in accordance with the Declaration of Helsinki. All patients signed a written informed consent.