{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:14:13Z","timestamp":1783937653389,"version":"3.55.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There is currently no consensus on optimal duration of antibiotic treatment in febrile neutropenia. We report on the clinical impact of implementation of antibiotic de-escalation and discontinuation strategies based on the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations in high-risk hematological patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We studied 446 admissions after introduction of an ECIL-4\u2013based protocol (hereafter \u201cECIL-4 group\u201d) in comparison to a historic cohort of 512 admissions. Primary clinical endpoints were the incidence of infectious complications including septic shock, infection-related intensive care unit (ICU) admission, and overall mortality. Secondary endpoints included the incidence of recurrent fever, bacteremia, and antibiotic consumption.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Bacteremia occurred more frequently in the ECIL-4 group (46.9% [209\/446] vs 30.5% [156\/512]; P\u2005&amp;lt;\u2005.001), without an associated increase in septic shock (4.7% [21\/446] vs 4.5% [23\/512]; P\u2005=\u2005.878) or infection-related ICU admission (4.9% [22\/446] vs 4.1% [21\/512]; P\u2005=\u2005.424). Overall mortality was significantly lower in the ECIL-4 group (0.7% [3\/446] vs 2.7% [14\/512]; P\u2005=\u2005.016), resulting mainly from a decrease in infection-related mortality (0.4% [2\/446] vs 1.8% [9\/512]; P\u2005=\u2005.058). Antibiotic consumption was significantly reduced by a median of 2 days on antibiotic therapy (12 vs 14; P\u2005=\u2005.001) and 7 daily antibiotic doses (17 vs 24; P\u2005&amp;lt;\u2005.001) per admission period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our results support implementation of ECIL-4 recommendations to be both safe and effective based on real-world data in a large high-risk patient population. We found no increase in infectious complications and total antibiotic exposure was significantly reduced.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofab624","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T17:02:11Z","timestamp":1640278931000},"source":"Crossref","is-referenced-by-count":42,"title":["Safety and Efficacy of Antibiotic De-escalation and Discontinuation in High-Risk Hematological Patients With Febrile Neutropenia: A Single-Center Experience"],"prefix":"10.1093","volume":"9","author":[{"given":"Anke","family":"Verlinden","sequence":"first","affiliation":[{"name":"Department of Haematology, Antwerp University Hospital, Edegem, Belgium"},{"name":"Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde","family":"Jansens","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"},{"name":"Department of Infection Control and Microbiology, Antwerp University Hospital, Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herman","family":"Goossens","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"},{"name":"Department of Infection Control and Microbiology, Antwerp University Hospital, Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Anguille","sequence":"additional","affiliation":[{"name":"Department of Haematology, Antwerp University Hospital, Edegem, Belgium"},{"name":"Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zwi N","family":"Berneman","sequence":"additional","affiliation":[{"name":"Department of Haematology, Antwerp University Hospital, Edegem, Belgium"},{"name":"Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried A","family":"Schroyens","sequence":"additional","affiliation":[{"name":"Department of Haematology, Antwerp University Hospital, Edegem, Belgium"},{"name":"Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain P","family":"Gadisseur","sequence":"additional","affiliation":[{"name":"Department of Haematology, Antwerp University Hospital, Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"2022020901594381400_CIT0001","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1086\/383050","article-title":"Management of fever in neutropenic patients with different risks of complications.","volume":"39","author":"Klastersky","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2022020901594381400_CIT0002","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1200\/JCO.2012.45.8661","article-title":"Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline.","volume":"31","author":"Flowers","year":"2013","journal-title":"J Clin Oncol"},{"key":"2022020901594381400_CIT0003","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1016\/S0959-8049(01)00461-0","article-title":"Management of infection in cancer patients. studies of the EORTC International Antimicrobial Therapy Group (IATG).","volume":"38","author":"Viscoli","year":"2002","journal-title":"Eur J Cancer"},{"key":"2022020901594381400_CIT0004","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1002\/cncr.21847","article-title":"Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients.","volume":"106","author":"Kuderer","year":"2006","journal-title":"Cancer"},{"key":"2022020901594381400_CIT0005","doi-asserted-by":"crossref","first-page":"3799","DOI":"10.1128\/AAC.02561-14","article-title":"Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia.","volume":"58","author":"Rosa","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"key":"2022020901594381400_CIT0006","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1093\/cid\/cir073","article-title":"Clinical practice guideline for the use of antimicrobial 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The design, analysis, and reporting of clinical trials on the empirical antibiotic management of the neutropenic patient. 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