{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:13:11Z","timestamp":1783937591730,"version":"3.55.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Early antibiotic discontinuation according to the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations is not systematically applied in high-risk neutropenic patients with haematological malignancies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective multicentre observational study was conducted over 2\u2005years to evaluate the safety of early antibiotic discontinuation for fever of unknown origin (FUO) during neutropenia after induction chemotherapy or HSCT, in comparison with a historical cohort. We used Cox proportional hazards models, censored on neutropenia resolution, to analyse factors associated with febrile recurrence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 147 included patients in the ECIL-4 cohort, mainly diagnosed with acute leukaemia (n\u200a=\u200a104, 71%), antibiotics were discontinued during 170 post-chemotherapy neutropenic episodes. In comparison with the historical cohort of 178 episodes of neutropenia without antibiotic discontinuation, no significant differences were observed regarding febrile recurrences [71.2% (121\/170) versus 71.3% (127\/178), P\u200a=\u200a0.97], admission in ICUs [6.5% (11\/170) versus 11.2% (20\/178), P\u200a=\u200a0.17], septic shock [0.6% (1\/170) versus 3.9% (7\/178), P\u200a=\u200a0.07] and 30\u2005day mortality [1.4% (2\/147) versus 2.7% (4\/150), P\u200a=\u200a0.084]. In the ECIL-4 cohort, the rate of bacteraemia in case of febrile recurrence was higher [27.1% (46\/170) versus 11.8% (21\/178), P\u200a&amp;lt;\u200a0.01] and antibiotic consumption was significantly lower (15.5 versus 19.9\u2005days, P\u200a&amp;lt;\u200a0.001). After early antibiotic discontinuation according to ECIL-4 recommendations, enterocolitis was associated with febrile recurrence [HR\u200a=\u200a2.31 (95% CI\u200a=\u200a1.4\u20133.8), P\u200a&amp;lt;\u200a0.001] and stage III\u2013IV oral mucositis with bacteraemia [HR\u200a=\u200a2.26 (95% CI\u200a=\u200a1.22\u20134.2), P\u200a=\u200a0.01].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>After an FUO episode in high-risk neutropenia, compliance with ECIL-4 recommendations for early antibiotic discontinuation appears to be safe and mucosal damage was associated with febrile recurrence and bacteraemia. Prospective interventional studies are warranted to assess this strategy in high-risk neutropenic patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkac190","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T12:41:36Z","timestamp":1656074496000},"page":"2546-2556","source":"Crossref","is-referenced-by-count":21,"title":["Safety and risk of febrile recurrence after early antibiotic discontinuation in high-risk neutropenic patients with haematological malignancies: a multicentre observational study"],"prefix":"10.1093","volume":"77","author":[{"given":"Raphael","family":"Paret","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Brest , Brest , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amandine","family":"Le Bourgeois","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Universit\u00e9 de Nantes , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga\u00eblle","family":"Guillerm","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital of Brest , Brest , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit","family":"Tessoulin","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Universit\u00e9 de Nantes , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sch\u00e9h\u00e9razade","family":"Rezig","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Brest , Brest , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gastinne","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Universit\u00e9 de Nantes , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Anne","family":"Couturier","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital of Brest , Brest , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9722-2029","authenticated-orcid":false,"given":"David","family":"Boutoille","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Nantes and CIC 1413 , Nantes , France"},{"name":"Nantes Universit\u00e9, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology , UMR 1064, F-44000 Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Lecomte","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Nantes and CIC 1413 , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Ader","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Lyon , Lyon , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Le Gouill","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Universit\u00e9 de Nantes , Nantes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9verine","family":"Ansart","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Brest , Brest , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Philippe","family":"Talarmin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper , Quimper , 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