Imipenem/cilastatin with or without glycopeptide as initial antibiotic therapy for recipients of autologous stem cell transplantation: results of a Spanish multicenter study.
We analyzed the efficacy of imipenem/cilastatin alone (group I, 197 patients) or in combination with a glycopeptide (group I + G, 231 patients) as first-line antibiotic therapy for 2 consecutive cohorts of autologous stem cell transplantation (ASCT) recipients with febrile neutropenia. From June 2001 to June 2002, patients received imipenem/cilastatin (500 mg/6 hours), and from July 2002 to December 2003, they received imipenem/cilastatin as for group I plus a glycopeptide (vancomycin, 1 g/12 hours or teicoplanin, 400 mg/day). Fever of unknown origin accounted for 33.5% of episodes (66 patients) in group I and 50% of episodes (116 patients) in group I + G (P = .005). Bacteremia occurred in 55 patients (28%) in group I and in 51 patients (22%) in group I + G (P = .16). Resolution of fever without modification of the therapy regimen was observed in 108 patients (55%) and 159 patients (69%) in groups I and I + G, respectively (P = .003). The median interval to defervescence (4 days) and overall mortality were similar between groups. Inclusion of a glycopeptide in the initial antibiotic regimen for febrile neutropenia results in a higher success rate without modifying the regimen. However, glycopeptide inclusion does not improve the interval to defervescence or mortality rate.
de la Rubia
Javier
J
Hospital La Fe, Valencia, Spain.
Montesinos
Pau
P
Martino
Rodrigo
R
Jarque
Isidro
I
Rovira
Montserrat
M
Vázquez
Lourdes
L
López
Javier
J
Batlle
Montserrat
M
de la Cámara
Rafael
R
Juliá
Antoni
A
Lahuerta
Juan J
JJ
Debén
Guillermo
G
Díaz
Joaquin
J
García
Raimundo
R
Sanz
Miguel A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D015377:Cilastatin / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006020:Glycopeptides / Q000008:administration & dosage*; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000401:mortality; D011480:Protease Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D013030:Spain; D033581:Stem Cell Transplantation; D015996:Survival Rate; D017334:Teicoplanin / Q000008:administration & dosage; D014182:Transplantation, Autologous; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D011480:Protease Inhibitors; D015377:Cilastatin; D017334:Teicoplanin; D014640:Vancomycin; D015378:Imipenem