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Published on: May 27, 2011
Empiric Imipenem/Cilastatin/Relebactam for Febrile Neutropenia After Allogeneic Hematopoietic Stem Cell
Dao-Xing Deng1, Ting Wang1, Hui Sun1
1Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Cell and Gene Therapy for Hematologic Malignancies, Peking University, Beijing, 100044, People's Republic of China.
Abstract:
Febrile neutropenia develops in approximately three-quarters of recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among them, carbapenem-resistant Enterobacterales (CRE) associated mortality reaches up to 70%. Thus, rapid identification of CRE-high-risk patients and prompt empiric CRE coverage are critical. Two allo-HSCT recipients whose febrile neutropenia persisted on empiric carbapenem were promptly escalated to imipenem/cilastatin/relebactam, alone or combined with aztreonam and tigecycline-before culture confirmation. Defervescence occurred within 24-48 h, inflammatory markers declined progressively, and clinical infection control was achieved. Successful neutrophil and platelet engraftment followed. Immediate empiric imipenem/cilastatin/relebactam for CRE-high-risk allo-HSCT recipients with febrile neutropenia rapidly controlled infections and permitted successful hematopoietic recovery. Prospective studies are warranted.
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