Objectives:
Information on the efficacy of extended meropenem administration in neutropenic patients is scarce. our objective was to determine whether the administration of meropenem in a 4 h extended infusion (ei) leads to a better clinical outcome in patients with febrile neutropenia than the conventional short infusion (si).
Methods:
This was a retrospective observational study. the subjects were neutropenic patients who presented with fever after receiving haematopoietic stem-cell transplantation or induction chemotherapy for acute myeloid leukaemia. the primary endpoint was the success of treatment after 5 days of meropenem therapy, defined as follows: the disappearance of fever leading to a maintained (β₯ 24 h) feverless state; the resolution or improvement of the clinical signs and symptoms of infection; the absence of persistent or breakthrough bacteraemia; and no additional antibiotics prescribed because of an unsatisfactory clinical evolution.
Results:
Eighty-eight patients received meropenem (1 g/8 h) in si and 76 received the same dose in ei. treatment success on day 5 was superior in the ei group [52/76 (68.4%) versus 36/88 (40.9%); p<0.001]. meropenem administered in ei was independently associated with success (or 3.13, 95% ci 1.61-6.10). fewer additional antibiotics were prescribed in the ei group during the first 5 days of treatment [20/76 (26.3%) versus 44/88 (50.0%); p=0.002]. using kaplan-meier survival analysis a more prompt defervescence and a faster decrease in c-reactive protein concentration were observed in the ei group (p=0.021 and p=0.037, respectively). there were no significant differences in the length of hospital stay and in the mortality rate.
Conclusions:
Meropenem administration in ei results in a better clinical outcome for febrile neutropenia episodes, with fewer additional antibiotics needed.