Safety and Efficacy of Antibiotic De-escalation and Discontinuation in High-Risk Hematological Patients With Febrile Neutropenia: A Single-Center Experience.

Background: There is currently no consensus on optimal duration of antibiotic treatment in febrile neutropenia. We report on the clinical impact of implementation of antibiotic de-escalation and discontinuation strategies based on the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations in high-risk hematological patients.

Methods: We studied 446 admissions after introduction of an ECIL-4-based protocol (hereafter "ECIL-4 group") in comparison to a historic cohort of 512 admissions. Primary clinical endpoints were the incidence of infectious complications including septic shock, infection-related intensive care unit (ICU) admission, and overall mortality. Secondary endpoints included the incidence of recurrent fever, bacteremia, and antibiotic consumption.

Results: Bacteremia occurred more frequently in the ECIL-4 group (46.9% [209/446] vs 30.5% [156/512];  < .001), without an associated increase in septic shock (4.7% [21/446] vs 4.5% [23/512];  = .878) or infection-related ICU admission (4.9% [22/446] vs 4.1% [21/512];  = .424). Overall mortality was significantly lower in the ECIL-4 group (0.7% [3/446] vs 2.7% [14/512];  = .016), resulting mainly from a decrease in infection-related mortality (0.4% [2/446] vs 1.8% [9/512];  = .058). Antibiotic consumption was significantly reduced by a median of 2 days on antibiotic therapy (12 vs 14;  = .001) and 7 daily antibiotic doses (17 vs 24;  < .001) per admission period.

Conclusions: Our results support implementation of ECIL-4 recommendations to be both safe and effective based on real-world data in a large high-risk patient population. We found no increase in infectious complications and total antibiotic exposure was significantly reduced.