title: Outpatient treatment with intravenous antimicrobial therapy and oral levofloxacin in patients with febrile neutropenia and hematological malignancies.
abstract: The purpose of this study was to evaluate outcomes such as success of the initial therapy, failure of outpatient treatment, and death in outpatient treatment during intravenous antimicrobial therapy in patients with febrile neutropenia (FN) and hematological malignancies. In addition, clinical and laboratory data and the Multinational Association for Supportive Care of Cancer index (MASCC) were compared with failure of outpatient treatment and death. In a retrospective study, we evaluated FN following chemotherapy events that were treated initially with cefepime, with or without teicoplanin and replaced by levofloxacin after 48 h of defervescence in patients with good general conditions and ANC>500/mm3. Of the 178 FN episodes occurred in 126 patients, we observed success of the initial therapy in 63.5% of the events, failure of outpatient treatment in 20.8%, and death in 6.2%. The success rate of oral levofloxacin after defervescence was 99% (95 out of 96). Using multivariate analysis, significant risks of failure of outpatient treatment were found to be smoking (odds ratio (OR) 3.14, confidence interval (CI) 1.14-8.66; p=0.027) and serum creatinine levels>1.2 mg/dL (OR 7.97, CI 2.19-28.95; p=0.002). With regard to death, the risk found was oxygen saturation by pulse oximetry<95% (OR 5.8, IC 1.50-22.56; p=0.011). Using the MASCC index, 165 events were classified as low risk and 13 as high risk. Failure of outpatient treatment was reported in seven (53.8%) high-risk and 30 (18.2%) low-risk episodes (p=0.006). In addition, death occurred in seven (4.2%) low-risk and four (30.8%) high-risk events (p=0.004). Ours results show that MASCC index was able to identify patients with high risk. In addition, non-smoking, serum creatinine levels≤1.2 mg/dL, and oxygen saturation by pulse oximetry≥95% were protection factors.
authors.affiliation: Departamento de Hematologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, R. Dr. Eneas de Carvalho Aguiar, Av 155-1o andar, sala 61-Cerqueira César, CEP 05403-000, São Paulo, São Paulo, Brazil. dr.marcelobellesso@gmail.com
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bellesso
authors.forename: Silvia Figueiredo
authors.initials: SF
authors.lastname: Costa
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Pracchia
authors.forename: Lucia Cristina
authors.initials: LC
authors.lastname: Santos Dias
authors.forename: Dalton
authors.initials: D
authors.lastname: Chamone
authors.forename: Pedro Enrique
authors.initials: PE
authors.lastname: Dorlhiac-Llacer
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D005334:Fever / Q000188:drug therapy* / Q000503:physiopathology; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D018718:Home Infusion Therapy; D006801:Humans; D007275:Injections, Intravenous; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000503:physiopathology; D015242:Ofloxacin / Q000008:administration & dosage* / Q000627:therapeutic use*; D012189:Retrospective Studies; D017334:Teicoplanin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D017334:Teicoplanin; D064704:Levofloxacin; D000077723:Cefepime; D015242:Ofloxacin