High risk febrile neutropenia: success rate of antibiotic schemes used in hematology department

Background: Patients receiving chemotherapy (CT) for haematological malignancies usually present febrile neutropenia (FN), defined as fever and neutropenia <0.5 x 109/L. The usual treatment is empirical (antibiotics with known action against the usual pathogens in place). Objective: To compare the success rate of the antibiotics schemes used for management of FN in the hematology department of Centro Médico Nacional“20 de Noviembre”.Methods: A randomized, retrospective, longitudinal, descriptive and comparative study of FN cases between 1994 and 2014 was conducted. The results of ceftriaxone/amikacin, ceftazidime/amikacin, imipenem, quinolones and cefepime were compared. The principal outcome was to determine the success (defined as disappearance of fever for 4 straight days, before 15 days of treatment, without changing antibiotics) rate with each scheme. Results: We studied 493 episodes. Mean age was 38 years (16-92). Fifty-three percent were female. Predominant neoplasia: acute leukemia (59% lymphoid and 32% myeloid). Source of infection was identified in 63% of cases. We eliminated 25 cases. There were thirty-three deaths (7%). There were 402 successful cases (82%). There was no difference (p> 0.26) between the first four schemes. Only cefepime was less effective (p = 0.04), with 68% of success. Conclusion: No difference in success rate between the several antibiotic scheme was observed, except for cefepime.