Interventional Antimicrobial Strategy for the Management of Infections in Neutropenic Patients with Hematologic Malignancies: Results of a Multi-Center Randomized Comparison of Antimicrobial Regiments

Abstract

The increasing intensity of antineoplastic chemotherapy for hematologic malignancies within recent years regularly induces severe and prolonged myelosuppression. Thus, overall therapeutic success for treating these diseases has become substantially dependent on effective supportive measures and on the control of infectious complications, in particular. While in the 1960s and 70s resistance against cytostatic therapy accounted for the majority of treatment failures, severe infections nowadays comprise the predominant cause of lethal outcome. In acute myeloid leukemia for example, up to 40%–50% of cases, and especially older patients succumb to infectious complications during induction chemotherapy [1–3]. Hence, it has become common practice to immediately initiate broad spectrum parenteral antibiotic therapy upon the first appearance of fever or other clinical signs of infections in these patients. In addition, however, a prospective interventional strategy is required since a considerable proportion of patients experiences multiple infectious episodes during prolonged myelosuppression or resistance to first-lineantimicrobial therapy. Therefore, it was the aim of the Paul Ehrlich Society for Chemotherapy to evaluate an interventional antimicrobial strategy comprised of three consecutive therapeutic phases using a prospective randomized comparison of different antimicrobial regiments at each escalation step [4].

A Paul-Ehrlich-Society for Chemotherapy study