Práticas de Antibioterapia em Neutropenia Febril de Alto Risco em Hospitais Portugueses

Abstract

Introduction and Objectives: Febrile Neutropenia (FN) poses potential severity, with frequent multidrug-resistant bacteria colonization in hemato-oncologic patients and discrepancies across international guidelines leading to divergence in antimicrobial practices. Our objective was to assess the variability of current practices in antimicrobial therapy of high-risk FN in Portuguese hospitals. Methods: Our online survey, open to clinical hematologists, included three clinical vignettes describing typical situations where narrow-spectrum empiric antibiotics (vignette 1), short-course therapy (vignette 2) and antimicrobial susceptibility test (AST) guided deescalation (vignette 3) could be performed. The remaining questions characterized clinical experience, department size and differentiation and decision-making process regarding FN antibiotic therapy. Results: The survey yielded 31 responses from eleven hospitals across four health administration regions. In vignette 1, all respondents preferred narrower-spectrum antibiotics. In vignette 2, one quarter opted for short-course therapy, one quarter for extending treatment until neutrophil count recovery and half for seven-day antibiotic duration. Short-course therapy was chosen more frequently when a FN protocol was available (40 versus 20%) and by senior specialists, those managing over 10 FN episodes monthly, those engaging in collaborative discussions, and those in large departments. In vignette 3, only one third chose deescalation. Junior hematologists chose AST-guided deescalation in 80% of cases, which was also more frequent in those with fewer than 2 FN episodes handled monthly, individual decision-making, small departments and lack of FN protocol. Discussion and Conclusion: Clinicians unanimously opted for internationally recommended narrower-spectrum empirical therapy in non-complicated high risk FN. Conversely, variability was found across all settings regarding antibiotic sparing short-course therapy and AST guided-deescalation, despite being recommended across european guidelines. Nevertheless, we observed that availability of an FN protocol favored both approaches and junior hematologists appropriated antibiotics to AST 60% more than senior specialists. In this light, consensus-building discussions on AST-guided de-escalation, standardization across all settings targeted in our study and development of local and national guidelines are warranted.