Early de-escalation of broad-spectrum antibiotic therapy in febrile neutropenia

To assess the effectiveness of an antimicrobial stewardship (AMS) intervention in haematology patients with febrile neutropenia (FN) on days of therapy (DOT) of empiric broad-spectrum antibiotic therapy (EBAT).

A single-centre, prospective cohort study of adult haematology patients admitted with FN from 1 May to 30 November 2022, compared with a retrospective cohort of patients admitted from 1 January 2018 to 31 December 2021. AMS intervention involved infectious diseases advice at weekly haematology meetings to encourage cessation of EBAT for patients with FN who were clinically stable with no isolated source. Primary outcome was duration and agent of EBAT DOT for patients without an identifiable source of fever.

For FN without an identifiable infective source, mean DOT was significantly shorter (7.1 vs 5.0 days (P = 0.04)). There was also a significant increase in the number of patients for whom EBAT was ceased prior to neutrophil recovery in the prospective cohort (40% vs 61%, P = 0.016). For patients without an identified source, duration of piperacillin-tazobactam and meropenem therapy decreased from 2018-2021 to 2022, with a trend towards significance (6.1 vs 4.4, P = 0.07; 12.7 vs 4.4, P = 0.07 respectively). There was no increase in recurrence of fever, antibiotic escalation, intensive care unit admission or death within 30 days in the post-intervention group.

We demonstrate that an AMS intervention decreased EBAT duration for patients without a source of infection.