Early Carbapenem De-escalation for Patients With High-Risk Febrile Neutropenia and Hematologic Malignancy

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Background Antibiotic stewardship programs recommend an early antibiotic de-escalation strategy in patients with hematologic malignancy-associated febrile neutropenia without documented infectious foci. Studies on its safety are scarce so there is low adherence to the recommendation. Methods This is analytical observational retrospective cohort study. Adult patients who were started on meropenem were included. The primary outcome was a composite of in-hospital mortality, fever recurrence and intensive care unit admission. Univariate and multivariate analysis were performed to determine associations with the primary outcome, controlling for confounding variables. Results One hundred twenty-eight patients (median age 51 years, interquartile range 34–63.5) were included, with lower occurrence of the primary outcome (21.2% vs 41.1%; P = 0.041) and intensive care unit admission (3% vs 16.8%; P = 0.044) in the early de-escalation group. In the multivariate analysis, de-escalation lowered the primary outcome risk (odds ratio [OR], 0.28; 95% confidence interval [95% CI], 0.09–0.85; P = 0.025), while neutropenia >10 days increased the risk (OR, 1.20; 95% CI, 1.09–1.33; P < 0.001). A lower risk was found in the autologous transplant (OR, 0.12; 95% CI, 0.21–0.63; P = 0.013) and the consolidation groups (OR, 0.09; 95% CI, 0.01–0.81; P = 0.031) compared to the induction chemotherapy group. Conclusions In hematologic malignancy-associated febrile neutropenia patients who remain hemodynamically stable and without documented infectious foci, the early de-escalation from carbapenem may be associated with better clinical outcomes. Prospective and multicenter studies are needed to confirm these findings.