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Piperacillin‐tazobactam vs. imipenem‐cilastatin as empirical therapy in hematopoietic stem cell transplantation recipients with febrile neutropenia
Author(s) -
Jing Yu,
Li Jian,
Yuan Lei,
Zhao Xiaoli,
Wang Quanshun,
Yu Li,
Zhou Daobin,
Huang Wenrong
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12685
Subject(s) - medicine , piperacillin/tazobactam , neutropenia , febrile neutropenia , hematopoietic stem cell transplantation , piperacillin , imipenem/cilastatin , transplantation , imipenem , tazobactam , intensive care medicine , antibiotics , chemotherapy , microbiology and biotechnology , antibiotic resistance , genetics , bacteria , pseudomonas aeruginosa , biology
This randomized, dual‐center study compared the efficacy and safety of piperacillin‐tazobactam ( PTZ ) and imipenem‐cilastatin ( IMP ) in hematopoietic stem cell transplantation ( HSCT ) recipients with febrile neutropenia. HSCT recipients with febrile neutropenia were randomized into two groups receiving either PTZ or IMP as initial empiric antibiotic. Endpoints were defervescence rate after empiric antibiotic for 48 h, success at end of therapy, and side effects. Defervescence within 48 h after empiric antibiotic was observed in 46 patients with PTZ (75.4%) and 59 patients with IMP (95.2%) (p = 0.002). Ten patients (10/46) in the PTZ group and two patients (2/59) in the IMP group switched empiric antibiotics due to recurrent fever (p = 0.005). Success of initial antibiotic with modification was achieved in 34 patients with PTZ (55.7%) and 53 patients with IMP (85.5%) at the end of therapy (p = 0.001). To treat the bacteremia, seven of 10 patients in the PTZ group and one of eight patients in the IMP group needed to switch the empiric antibiotic (p = 0.025). Compared with PTZ , IMP had more gastrointestinal adverse events (p = 0.045). This study demonstrates that IMP had better efficacy than PTZ as an empiric antibiotic for febrile neutropenia in the HSCT setting, but with more gastrointestinal side reactions.