Variation in Clinical Practice and Attitudes on Antibacterial Management of Fever and Neutropenia in Patients With Hematologic Malignancy: A Survey of Cancer Centers Across the United States.
Variation in Clinical Practice and Attitudes on Antibacterial Management of Fever and Neutropenia in Patients With Hematologic Malignancy: A Survey of Cancer Centers Across the United States.
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血液系统恶性肿瘤患者的临床实践和对发烧和中性粒细胞减少症抗菌治疗的态度的变化：美国各地癌症中心的调查。
DOI：
10.1093/ofid/ofac005
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发表时间：
2022-03
影响因子：
4.2
通讯作者：
Liu C
中科院分区：
文献类型：
--
作者：
Barreto JN;Aitken SL;Krantz EM;Nagel JL;Dadwal SS;Seo SK;Liu C
目前缺乏关于发热和中性粒细胞减少（FN）管理的信息，包括美国癌症中心的抗菌预防、经验性治疗和降级方法。这是一项对美国癌症中心的抗菌药物管理医生和药剂师进行的自我管理、电子、横断面调查。调查确定机构的做法和个人的态度FN管理的高风险癌症患者。一个5点李克特量表评估个人的态度。86家医院中有31家（36%）的供应商做出了回应，大多数（29/31，94%）医院都有FN管理指南。27/31（87%）的医院推荐预防性使用抗菌药物，其中左氧氟沙星为首选药物（23/27，85%）。头孢吡肟是最推荐的经验性FN治疗药物（26/29，90%）。大多数机构指南（26/29，90%）建议，除特定情况外，不要常规添加经验性革兰氏阳性药物。29家医院中的18家（62%）明确提供了经验性全身抗菌治疗降级的指导;然而，降级的时间根据临床情况而变化。在34名个体受访者中，大多数人同意在高危患者中使用抗生素预防（25，74%）。有趣的是，只有10名（29%）受访者表示同意抗生素预防的益处超过潜在危害的说法。大多数接受调查的美国癌症中心都有机构FN管理指南。近40%的中心缺乏抗生素降级指导，当建议存在时，方法存在异质性。需要进一步的研究来告知FN关于抗菌预防和治疗降级的指南。
Contemporary information regarding fever and neutropenia (FN) management, including approaches to antibacterial prophylaxis, empiric therapy, and de-escalation across US cancer centers, is lacking. This was a self-administered, electronic, cross-sectional survey of antimicrobial stewardship physicians and pharmacists at US cancer centers. The survey ascertained institutional practices and individual attitudes on FN management in high-risk cancer patients. A 5-point Likert scale assessed individual attitudes. Providers from 31 of 86 hospitals (36%) responded, and FN management guidelines existed in most (29/31, 94%) hospitals. Antibacterial prophylaxis was recommended in 27/31 (87%) hospitals, with levofloxacin as the preferred agent (23/27, 85%). Cefepime was the most recommended agent for empiric FN treatment (26/29, 90%). Most institutional guidelines (26/29, 90%) recommended against routine addition of empiric gram-positive agents except for specific scenarios. Eighteen of 29 (62%) hospitals explicitly provided guidance on de-escalation of empiric, systemic antibacterial therapy; however, timing of de-escalation was variable according to clinical scenario. Among 34 individual respondents, a majority agreed with use of antibiotic prophylaxis in high-risk patients (25, 74%). Interestingly, only 10 (29%) respondents indicated agreement with the statement that benefits of antibiotic prophylaxis outweigh potential harms. Most US cancer centers surveyed had institutional FN management guidelines. Antibiotic de-escalation guidance was lacking in nearly 40% of centers, with heterogeneity in approaches when recommendations existed. Further research is needed to inform FN guidelines on antibacterial prophylaxis and therapy de-escalation.
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影响因子：
50.5
作者：
Klastersky, J.;de Naurois, J.;Herrstedt, J.
通讯作者：
Herrstedt, J.
影响因子：
11.8
作者：
Freifeld, Alison G.;Bow, Eric J.;Wingard, John R.
通讯作者：
Wingard, John R.
影响因子：
14.2
作者：
Brigmon, M. M.;Bookstaver, P. Brandon;Al-Hasan, M. N.
通讯作者：
Al-Hasan, M. N.
影响因子：
39.2
作者：
BODEY, GP;BUCKLEY, M;FREIREICH, EJ
通讯作者：
FREIREICH, EJ
DOI：
10.1007/s10096-018-3328-1
发表时间：
2018-10-01
影响因子：
4.5
作者：
la Martire, Giulia;Robin, Christine;Cordonnier, Catherine
通讯作者：
Cordonnier, Catherine