LEATHER H, ORRICK J, WIGGINS L, RAMPHAL R, WINGARD JR; Interscience Conference on Antimicrobial Agents and Chemotherapy (41st : 2001 : Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2001 Dec 16-19; 41: abstract no. L-777.

Shands at the University of Florida, Gainesville, FL

BACKGROUND: CEF replaced ceftazidime (CAZ) at our institution for empiric monotherapy of FN in 4/98 due to increased resistance to CAZ among gram-negative bacteria. Because of the additional cost of CEF, a SDDRS was implemented for FN. All patients (pts) with FN receive CEF 2g q8h at the onset of fever. This is reduced to 1g q8h if at 48 hrs the pt is afebrile or at 72 hours if fevers persist but cultures are negative. METHODS: Data were collected prospectively. RESULTS: 408 episodes of FN occurred between 3/98 and 3/01 [36% leukemia (LK), 45% bone marrow transplant, 19% solid tumors (ST)]. The median ANC at the start of CEF was 19 x 10[9]/L [0-480], with a median duration of neutropenia of 10 days after starting CEF. Of the 408 pts, 19% had documented bacteremia (BA), 3% had infections at other sites and 78% were FUOs. Among BA, there were 28Coagulase negative staphylococci (CNS), 10 E. coli, 4 S. viridans, 10 Klebsiella spp., 8 P. aeuroginosa, 4 E. faecalis, 4 E. cloacae, and 18 less common pathogens. Superinfections occurred in 7.3% of episodes including VRE (8), CNS (10), E. faecium (3), B. fragilis (3), and other (13). Infectious mortality in the first 212 patients is 0.5%, and this compares favorably to 3.8% seen with earlier 2g non-SDDRS CEF studies at our institution. The median number of 2g and 1g doses received was 8 and 8 for AUTO, 10 and 11 for ALLO, 9 and 10 for LK, and 7 and 4 for ST pts. Vancomycin and aminoglycosides were added in 27.8%, and 15.6% of FN episodes. Compliance with the step-down approach was 81% and remains high. Based on our patient population the relative medication costs are: CEF 2g for all doses $245668, CAZ 2g for all doses $148272; and $167018 using the SDDRS approach. CONCLUSION: In a controlled setting it is safe, effective and cost-effective to implement a SDDRS for FN.

Publication Types:

• Meeting Abstracts

Keywords:

• Aminoglycosides
• Anti-Bacterial Agents
• Ceftazidime
• Cephalosporins
• Down Syndrome
• Fever
• Humans
• Leukemia
• Neoplasms
• Neutropenia
• Vancomycin
• cefepime
• methods

Other ID:

• GWAIDS0029864

UI: 102269496

From Meeting Abstracts