Evaluating the use of meropenem in hematologic patients with febrile neutropenia admitted to Meander Medical Centre

Abstract

Objective The Antibiotic Stewardship Team of Meander Medical Centre (MC) instigated a revaluation of its treatment protocol for hematologic patients admitted with febrile neutropenia. Current guidelines advise treating with meropenem for 72 hours, following therapy streamlining guided by microbiological cultures. In order to identify responsible adjustments to the current empiric meropenem regimen, this study aimed to determine the frequency of microorganisms resistant to alternative antibiotics, namely ceftazidime and piperacillin/tazobactam, in both prophylactic and diagnostic cultures.

Study design This retrospective, observational, single-centre study used a single cohort design and included adult patients with a hematologic malignancy and febrile neutropenia admitted between October 2018 and June 2022. Collected metadata included patient characteristics such as age and BMI, microbiologic cultures, and antibiotic treatments.

Results A total of 100 patients were recruited. One or more microorganisms resistant to ceftazidime or piperacillin/tazobactam were identified in blood and urine cultures in ten (10%) and four (4%) patients respectively. Empiric treatment with meropenem lasted longer than 72 hours as described in the protocol in 35 patients, and longer than 96 hours in 20 patients. In addition to identification of a microorganism indicating use of meropenem, persistent and reoccurring fever was noted as an argument for continued treatment.

Recommendations Meander MC can reduce the use of meropenem by changing the empiric treatment protocol for patients with febrile neutropenia. As this study showed a lower resistance frequency to piperacillin/tazobactam, this antibiotic is the recommend alternative. Furthermore, increased awareness of when to discontinue empiric meropenem amongst the hospital’s haematologists would lead to further reduction in their use of this broad-spectrum reserve antibiotic.