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01.12.2023 | Research

Low utilization of vancomycin in febrile neutropenia: real-world evidence from 4 Brazilian centers

verfasst von: Jessica Fernandes Ramos, André Domingues Pereira, Maria Cristina Nunez Seiwald, Larissa Simão Gandolpho, Vinicius Campos Molla, Mariana Guaraná, Simone A. Nouér, Marcio Nucci, Celso Arrais Rodrigues

Erschienen in: Supportive Care in Cancer | Ausgabe 12/2023

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Abstract

Purpose

The prompt initiation of a betalactam antibiotic in febrile neutropenic patients is considered standard of care, while the empiric use of vancomycin is recommended by guidelines in specific situations, with a low level of evidence. The objective of this study was to assess the utilization of vancomycin in the management of febrile neutropenia within four Brazilian medical centers that implemented more stringent criteria for its administration.

Methods

A comprehensive retrospective analysis was performed encompassing all instances of febrile neutropenia observed during the period from 2013 to 2019. The primary focus was to identify the reasons for initiating vancomycin therapy.

Results

A total of 536 consecutive episodes of febrile neutropenia were documented, involving 384 patients with a median age of 52 years (range 18–86). Chemotherapy preceded febrile neutropenia in 59.7% of cases, while 40.3% occurred after hematopoietic stem cell transplantation. The most prevalent underlying diseases were acute myeloid leukemia (26.5%) and non-Hodgkin's lymphoma (22%). According to international guidelines, vancomycin should have been initiated at the onset of fever in 145 episodes (27%); however, it was administered in only 27 cases (5.0%). Three episodes were associated with Staphylococcus aureus bacteremia, two of which were methicillin resistant. The 15-day and 30-day mortality rates were 5.0% and 9.9%, respectively.

Conclusions

The results of this study underscore the notably low utilization rate of vancomycin in cases of febrile neutropenia, despite clear indications outlined in established guidelines. These findings emphasize the importance of carefully implementing guideline recommendations, considering local epidemiological factors, especially when the strength of recommendation is weak.

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Titel: Low utilization of vancomycin in febrile neutropenia: real-world evidence from 4 Brazilian centers
verfasst von: Jessica Fernandes Ramos
André Domingues Pereira
Maria Cristina Nunez Seiwald
Larissa Simão Gandolpho
Vinicius Campos Molla
Mariana Guaraná
Simone A. Nouér
Marcio Nucci
Celso Arrais Rodrigues
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 12/2023
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-023-08152-0

Springer Medizin

Low utilization of vancomycin in febrile neutropenia: real-world evidence from 4 Brazilian centers