Journal Article Review Ppublish
PubMed: 42639738 DOI: 10.1093/jac/dkag294
Is there any role for empiric coverage of resistant Gram-positive bacteria in febrile neutropaenia?
J Antimicrob Chemother 81(9)
Authors: Marcio Nucci, Simone A Nouér
Affiliations
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-CH-UFRJ HUBrasil), Rua Prof. Rodolpho Paulo Rocco 255, Sala 4A12, Rio de Janeiro 21941-913, Brazil.
- Department of Hematology, Grupo Oncoclinicas, Rio de Janeiro, Brazil.
Abstract
Vancomycin is still frequently started empirically in febrile neutropaenia, especially when patients are severely ill. Yet randomized evidence concerning anti-Gram-positive agents as a class shows no mortality benefit from routine empirical coverage, and contemporary cohort studies consistently link early shock and death to Gram-negative bacilli, inadequate Gram-negative coverage, pneumonia, septic shock and candidaemia rather than to Gram-positive bacteraemia or inadequate Gram-positive coverage. MRSA nasal screening further supports avoiding empirical anti-MRSA therapy in screen-negative patients. The default response to febrile neutropaenia should therefore be rapid, locally informed anti-pseudomonal beta-lactam therapy, with vancomycin reserved for documented infection or narrowly defined syndromes with a high pre-test probability of resistant Gram-positive disease.
MeSH
Drug Therapy, Gram-Positive Bacteria, Therapeutics, Bacteria