Empiric antibiotic regimen for febrile neutropenia in cancer patients: a tertiary oncology center experience.
In a retrospective cohort of 208 cancer patients with febrile neutropenia, a stepwise carbapenem-sparing antibiotic protocol was associated with reported clinical improvement without first-line escalation for most patients, although its simulated pathogen coverage was lower than that of broader regimens and pediatric patients were excluded.
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In a retrospective cohort of 208 cancer patients with febrile neutropenia, a stepwise carbapenem-sparing antibiotic protocol was associated with reported clinical improvement without first-line escalation for most patients, although its simulated pathogen coverage was lower than that of broader regimens and pediatric patients were excluded.
Research significance
The record supports the feasibility of a carbapenem-sparing, stepwise empiric strategy in this adult tertiary-center cohort; it may reduce unnecessary broad-spectrum antibiotic exposure while retaining clinical effectiveness, but pediatric efficacy, comparative benefit, safety, and resistance effects remain untested in the supplied evidence.
Source abstract
INTRODUCTION: Neutropenia is a major obstacle in the care of cancer patients. It is common in patients receiving chemotherapy, associated with significant morbidity and mortality, it occurs in 5-30% among patients with solid tumors and exceeds 80% of those undergoing chemotherapy for hematologic malignancies. OBJECTIVES: This study primary endpoint was to assess the clinical outcome of the different antibiotic regimens. The secondary endpoint was to assess the microbiological appropriateness of antibiotic coverage of our carbapenem-sparing empiric regimen for neutropenic fever in patients admitted to the hemato-oncology departments to Augusta Victoria Hospital. METHODS: Patients data were extracted from the hospital health information system for all entries pertaining to neutropenic fever from 1 January 2022 to 30 November 2025. Statistical comparison between empiric antibiotic regimens was not performed because treatment escalation followed a predefined sequential protocol, resulting in non-independent groups. Assessment of antimicrobial appropriateness was completed using IBM SPSS Statistics via Fisher's Exact Test. Patient data analyzed, included antibiotic classes used, bacterial culture results, antimicrobial sensitivity testing, cause of fever and outcome of antimicrobial treatment. Exclusions criteria included prophylaxis prescriptions for neutropenic fever and pediatric patients. RESULTS: Overall, 208 patients with febrile neutropenia were evaluated between January 1st, 2022, to November, 2025th 2025. Hematology patients represented a major proportion compared to oncology (56.70% and 43.30%, respectively). Our institutional protocol, represented by ceftazidime and amikacin (the last is replaced with ciprofloxacin for patients with renal failure) was the most prescribed regimen (78.1%), followed by piperacillin-tazobactam ± vancomycin (16.4%) and finally meropenem (5.5%). Our institutional regimen was theoretically appropriate in 44.4% of cases, compared to piperacillin-tazobactam ± vancomycin (55.6%) and meropenem (88.9%). CONCLUSION: The institutional stepwise empiric antibiotic protocol demonstrated high overall clinical response rates in patients with febrile neutropenia, with most patients achieving improvement without requiring escalation beyond first-line therapy. Simulated microbiological assessment suggested increasing pathogen coverage with broader-spectrum regimens, although this should be interpreted cautiously given the limited number of positive culture isolates. These findings support the effectiveness of the current protocol while emphasizing the importance of balancing microbiological coverage with antimicrobial stewardship principles.