title: Effect of meropenem administration in extended infusion on the clinical outcome of febrile neutropenia: a retrospective observational study.
abstract: OBJECTIVE
  Information on the efficacy of extended meropenem administration in neutropenic patients is scarce. Our objective was to determine whether the administration of meropenem in a 4 h extended infusion (EI) leads to a better clinical outcome in patients with febrile neutropenia than the conventional short infusion (SI).
  
  
  METHODS
  This was a retrospective observational study. The subjects were neutropenic patients who presented with fever after receiving haematopoietic stem-cell transplantation or induction chemotherapy for acute myeloid leukaemia. The primary endpoint was the success of treatment after 5 days of meropenem therapy, defined as follows: the disappearance of fever leading to a maintained (≥ 24 h) feverless state; the resolution or improvement of the clinical signs and symptoms of infection; the absence of persistent or breakthrough bacteraemia; and no additional antibiotics prescribed because of an unsatisfactory clinical evolution.
  
  
  RESULTS
  Eighty-eight patients received meropenem (1 g/8 h) in SI and 76 received the same dose in EI. Treatment success on day 5 was superior in the EI group [52/76 (68.4%) versus 36/88 (40.9%); P<0.001]. Meropenem administered in EI was independently associated with success (OR 3.13, 95% CI 1.61-6.10). Fewer additional antibiotics were prescribed in the EI group during the first 5 days of treatment [20/76 (26.3%) versus 44/88 (50.0%); P=0.002]. Using Kaplan-Meier survival analysis a more prompt defervescence and a faster decrease in C-reactive protein concentration were observed in the EI group (P=0.021 and P=0.037, respectively). There were no significant differences in the length of hospital stay and in the mortality rate.
  
  
  CONCLUSIONS
  Meropenem administration in EI results in a better clinical outcome for febrile neutropenia episodes, with fewer additional antibiotics needed.
authors.affiliation: Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain cfeher@clinic.ub.es.
authors.forename: Csaba
authors.initials: C
authors.lastname: Fehér
authors.affiliation: Department of Haematology and Bone Marrow Transplant Unit, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.affiliation: Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain University of Barcelona, Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.affiliation: Department of Haematology and Bone Marrow Transplant Unit, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Esteve
authors.affiliation: Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Martínez
authors.affiliation: Microbiology Service, Hospital Clínic, Barcelona, Spain Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-University of Barcelona, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.affiliation: Department of Haematology and Bone Marrow Transplant Unit, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Carreras
authors.affiliation: Department of Haematology and Bone Marrow Transplant Unit, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Department of Haematology and Bone Marrow Transplant Unit, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Department of Haematology and Bone Marrow Transplant Unit, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Suárez-Lledó
authors.affiliation: Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000188:drug therapy*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000628:therapy; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D012189:Retrospective Studies; D013845:Thienamycins / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D013845:Thienamycins; D000077731:Meropenem
keywords: neutropenic fever; prolonged antibiotic infusion; β-lactams