The Use of Intravenous Antibiotics at the Onset of Neutropenia in Patients Receiving Outpatient-Based Hematopoietic Stem Cell Transplants
The Use of Intravenous Antibiotics at the Onset of Neutropenia in Patients Receiving Outpatient-Based Hematopoietic Stem Cell Transplants
复制标题
接受门诊造血干细胞移植的患者出现中性粒细胞减少症时静脉注射抗生素的使用
作者：
Aziz Hamadah;Y. Schreiber;B. Toye;S. Mcdiarmid;L. Huebsch;C. Bredeson;J. Tay
在中性粒细胞减少症开始时使用经验性抗生素是治疗造血干细胞移植(HSCT)患者细菌感染的几种策略之一(经验性策略)。我们的HSCT计划的目标是在门诊环境中进行HSCT，在那里使用经验性抗生素策略。从2009年1月1日起，作为我们机构政策的一部分，接受造血干细胞移植的患者在没有发烧的情况下出现中性粒细胞减少时开始接受静脉注射抗生素；静脉预防策略。进行了一项前瞻性研究，以比较连续两个队列[2008年(经验性策略)与2009年(预防性策略)]接受HSCT的患者。在2008年1月1日至2009年12月31日期间共进行了238例造血干细胞移植，早期队列中有127例，晚期队列中有111例。与经验性策略相比，植入前预防性治疗的感染相关死亡率相似(3.6%比7.1%；p = 0.24)，但在接受自体造血干细胞移植的患者中降低(0%比6.8%；p = 0.03)。微生物学研究显示，与经验性策略相比，接受预防性治疗的患者植入前的血流感染和临床记录感染分别减少了11.7%和28.3%(p = 0.001)、9.9%和24.4%(p = 0.003)和(18.2%vs.33.9%p = 0.007)。在接受门诊HSCT的患者中预防性使用每日一次的头孢曲松是安全的，在接受自体HSCT的患者中可能特别有效。有必要进行进一步的研究，以研究这一预防策略在门诊HSCT计划中的影响。
Empirical antibiotics at the onset of febrile neutropenia are one of several strategies for management of bacterial infections in patients undergoing Hematopoietic Stem Cell Transplant (HSCT) (empiric strategy). Our HSCT program aims to perform HSCT in an outpatient setting, where an empiric antibiotic strategy was employed. HSCT recipients began receiving intravenous antibiotics at the onset of neutropenia in the absence of fever as part of our institutional policy from 01 Jan 2009; intravenous Prophylactic strategy. A prospective study was conducted to compare two consecutive cohorts [Year 2008 (Empiric strategy) vs. Year 2009 (Prophylactic strategy)] of patients receiving HSCT. There were 238 HSCTs performed between 01 Jan 2008 and 31 Dec 2009 with 127 and 111 in the earlier and later cohorts respectively. Infection-related mortality pre- engraftment was similar with a prophylactic compared to an empiric strategy (3.6% vs. 7.1%; p = 0.24), but reduced among recipients of autologous HSCT (0% vs. 6.8%; p = 0.03). Microbiologically documented, blood stream infections and clinically documented infections pre-engraftment were reduced in those receiving a prophylactic compared to an empiric strategy, (11.7% vs. 28.3%; p = 0.001), (9.9% vs. 24.4%; p = 0.003) and (18.2% vs. 33.9% p = 0.007) respectively. The prophylactic use of intravenous once-daily ceftriaxone in patients receiving outpatient based HSCT is safe and may be particularly effective in patients receiving autologous HSCT. Further studies are warranted to study the impact of this Prophylactic strategy in an outpatient based HSCT program.
影响因子：
4.3
作者：
Woolfrey, Ann;Lee, Stephanie J.;Gooley, Ted A.;Malkki, Mari;Martin, Paul J.;Pagel, John M.;Hansen, John A.;Petersdorf, Effie
通讯作者：
Petersdorf, Effie
影响因子：
45.3
作者：
BEARMAN, SI;APPELBAUM, FR;THOMAS, ED
通讯作者：
THOMAS, ED
DOI：
10.1056/nejmoa1004383
发表时间：
2010-11-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Gooley TA;Chien JW;Pergam SA;Hingorani S;Sorror ML;Boeckh M;Martin PJ;Sandmaier BM;Marr KA;Appelbaum FR;Storb R;McDonald GB
通讯作者：
McDonald GB