A randomized comparison of empiric or pre-emptive antibiotic therapy after hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 40; no. 2; pp. 157 - 163
• Main Authors: SLAVIN, M. A, GRIGG, A. P, SCHWARER, A. P, SZER, J, SPENCER, A, SAINANI, A, THURSKY, K. A, ROBERTS, A. W
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.07.2007
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Autografts; Bacteremia - drug therapy; Bacteremia - etiology; Bacteremia - prevention & control; Bacterial Infections - drug therapy; Bacterial Infections - etiology; Bacterial Infections - prevention & control; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Cefepime; Cephalosporins - administration & dosage; Cephalosporins - therapeutic use; Complications and side effects; Dosage and administration; Female; Fever; Fever - drug therapy; Fever - etiology; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Humans; Intravenous administration; Male; Medical sciences; Neutropenia; Neutropenia - drug therapy; Neutropenia - etiology; Other diseases. Hematologic involvement in other diseases; Patients; Reagents; Risk factors; Stem cell transplantation; Stem cells; Therapy; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome; Australia; Leukopenia; Hematology; SCT; Stem cell; Hematopoietic cell; Hemopathy; pre-emptive; Prevention; Antibiotic; Randomization; Treatment; Graft; empiric; antibiotics; Comparative study; Neutropenia
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705686

We performed a randomized comparison of pre-emptive and empiric antibiotic therapy for adult patients undergoing allogeneic or autologous stem cell transplantation. One hundred and fifty-three patients were randomized to receive cefepime either pre-emptively on the day that neutropenia (ANC<1.0 x 10(9) cells/l) developed irrespective of the presence of fever, or at onset of fever and neutropenia (empiric). Although there was no difference between the two arms in the proportion of patients developing fever or in the median number of days of fever, the time to onset of fever was a mean of 1 day longer in each patient on the pre-emptive arm (log rank P<0.001). The number of patients with bloodstream infections was significantly reduced in those receiving pre-emptive therapy (16/75) compared to the empiric arm (31/76) (P<0.01) but this did not translate into an appreciable clinical benefit as measured by days of hospitalization, time to engraftment, use of additional antimicrobial agents or mortality at 30 days. This study does not support the use of pre-emptive intravenous antibiotic therapy in adult stem cell transplant recipients.