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Management of infection prophylaxis in Dutch patients with myelodysplastic syndromes, a web-based case vignette
Johanne Rozema1,2, Eric van Roon1,2, Lars Vogelzang1
1Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Objectives:
Infections are a major cause of morbidity and mortality in patients with myelodysplastic syndromes (MDS). The objective of the MINDSET study was to evaluate haematologists' management of infection prevention in MDS patients using a case vignette study and to assess the availability of guidelines.
Methods:
We conducted a web-based, nationwide survey amongst haematologists in the Netherlands between September and December 2021. The survey included a set of case vignettes. In addition, the availability of protocols was evaluated.
Results:
Sixty responses were obtained (23.6%). These responses were well distributed across hospital types as well as level of experience. No protocols regarding infection prophylaxis specifically for MDS patients were received. In the case vignette of a 75-year-old MDS patient, respondents would primarily prescribe infection prophylaxis in case of recurrent infections (96.7%) and neutropenia (75.0% for absolute neutrophil count [ANC] < 0.2 × 109 /L and 53.3% for ANC < 0.5 × 109 /L), especially in combination with hypomethylating agents (80.0%), lenalidomide (66.7%) or chemotherapy (51.7%). Respondents would predominantly choose antibacterial agents (85.0%), followed by antifungal agents (71.7%).
Conclusions:
This study showed diverse reasons and considerations of haematologists regarding whether to prescribe infection prophylaxis in MDS patients. Given the seriousness of infections in MDS patients, patient-tailored recommendations might be valuable in clinical decision-making.
Insights
Hematologists manage infection prevention in myelodysplastic syndromes (MDS) based on factors like neutropenia and recurrent infections, but specific guidelines are lacking. Patient-tailored recommendations are needed for better clinical decisions.
Area of Science:
- Hematology
- Infectious Disease Management
Background:
- Infections pose significant risks, causing morbidity and mortality in myelodysplastic syndromes (MDS) patients.
- Current infection prevention strategies in MDS require evaluation.
Purpose of the Study:
- To assess how hematologists manage infection prevention in MDS patients.
- To determine the availability of specific guidelines for infection prophylaxis in MDS.
- To analyze factors influencing prophylaxis decisions through case vignettes.
Main Methods:
- A nationwide web-based survey was conducted among Dutch hematologists from September to December 2021.
- The survey included case vignettes simulating MDS patient scenarios.
- The availability of institutional protocols for infection prophylaxis was assessed.
Main Results:
- Sixty hematologists responded (23.6% response rate), with diverse experience levels and hospital affiliations.
- No specific protocols for MDS infection prophylaxis were identified.
- Prophylaxis was commonly prescribed for neutropenia (ANC < 0.2 × 10⁹/L or < 0.5 × 10⁹/L) and recurrent infections, especially with specific MDS treatments.
- Antibacterial (85.0%) and antifungal (71.7%) agents were the preferred prophylactic choices.
Conclusions:
- Hematologists' approaches to infection prophylaxis in MDS vary.
- The lack of specific guidelines highlights a need for standardized, patient-tailored recommendations.
- Improved clinical decision-making for infection prevention in MDS is warranted.
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