A meta-analysis by IDIBELL and Bellvitge Hospital examines the use of beta-lactam antibiotics in febrile neutropenia

Febrile neutropenia is a complication that often occurs in patients with oncohematologic diseases who are receiving chemotherapy or stem cell transplantation. It is a complex syndrome in which only 20-30% of patients show clinical or microbiological signs of infection, and approximately 20% have bacteraemia. In addition, in recent years, an increase in infections caused by gram-negative bacteria has been observed in this group of vulnerable patients, as well as the emergence of resistance to antibiotics.

The treatment of febrile neutropenia is mainly based on the use of beta-lactam antibiotics. In this regard, the use of prolonged intravenous infusions of these antibiotics has been shown to improve outcomes in critically ill patients in intensive care units. This is because, with prolonged infusions, the antibiotic maintains an effective concentration for a longer time to fight the microorganisms responsible for the infection. However, there is still controversy about the potential benefits of this technique in patients with febrile neutropenia.

A recent meta-analysis has provided important data in this regard. The results of five studies have been reviewed, two of them randomized clinical trials, with a total of 691 episodes of febrile neutropenia. The effects of the use of beta-lactam antibiotics in intermittent infusions have been compared with prolonged infusions. The conclusion of the analysis has been that so far, we cannot demonstrate that prolonged infusions manage to reduce mortality, nor other aspects such as lowering fever, the use of vasoactive drugs, the length of hospitalization or adverse effects.

For this reason, the widespread use of extended beta-lactam infusion as an empiric treatment of febrile neutropenia cannot be recommended at this time, and further clinical trials are needed to determine whether there are subgroups of patients with this disease who may benefit from a prolonged infusion of these antibiotics.

The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.

IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).