{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:27:49Z","timestamp":1760059669243,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Febrile neutropenia is a critical complication in patients with hematological malignancies; immediate initiation of empirical treatment with a broad-spectrum agent is the standard of care. In this study, we aimed to evaluate the cost-effectiveness of long- and short-term antibiotic treatments. Methods: We conducted a retrospective cohort study. We collected data on admissions between 1 January 2018 and 31 December 2022. Adult patients treated with meropenem were included and treatment duration was categorized. Short-term treatment (STT) was defined as a period of 7 days or less, and long-term treatment (LTT) was defined as longer than 7 days. To comparatively estimate costs in both groups, it was hypothesized where STT patients were assumed to receive LTT. Three scenarios were modeled to calculate potential cost reductions. Results: In total, 151 high-risk patients were eligible, with 93 and 58 in the STT and LTT groups, respectively. Both groups exhibited similar clinical characteristics and statistically no significant differences in outcomes. The average costs for the STT and LTT groups were statistically significantly different at USD 9294.01 and USD 13,515.27, respectively. From the regression analysis, cost reductions per patient of USD 164, 527, and 690 were estimated for the three intervention scenarios. Conclusions: Notably, even though the clinical outcomes of STT were not statistically different from those of LTT, the cost of the STT group were statistically significantly lower than that of the LTT group. The early discontinuation of empirical meropenem treatment may offer financial advantages to healthcare systems.<\/jats:p>","DOI":"10.3390\/antibiotics14070653","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T06:56:54Z","timestamp":1751353014000},"page":"653","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Do We Need Meropenem Treatment Beyond 7 Days in Febrile Neutropenic Patients: A Cost-Effectiveness Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3382-2794","authenticated-orcid":false,"given":"Leyla","family":"Yumrukaya","sequence":"first","affiliation":[{"name":"Department of Pharmacy Management, Hacettepe University Faculty of Pharmacy, Ankara 06100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9087-8719","authenticated-orcid":false,"given":"Arnold","family":"Hagens","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University Medical Center Groningen, University of Groningen (RUG), 9700 AD Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7943-8715","authenticated-orcid":false,"given":"Ahmet \u00c7a\u011fkan","family":"\u0130nkaya","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06230, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6khan","family":"Metan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06230, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maarten","family":"Postma","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University Medical Center Groningen, University of Groningen (RUG), 9700 AD Groningen, The Netherlands"},{"name":"Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, 9700 AV Groningen, The Netherlands"},{"name":"Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia"},{"name":"Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selen","family":"Ye\u011feno\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Management, Hacettepe University Faculty of Pharmacy, Ankara 06100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6904-9473","authenticated-orcid":false,"given":"Murat","family":"Akova","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06230, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bachlitzanaki, M., Aletras, G., Bachlitzanaki, E., Messaritakis, I., Koukias, S., Koulouridi, A., Bachlitzanakis, E., Kaloeidi, E., Vakonaki, E., and Kontopodis, E. (2023). Evaluation of febrile neutropenia in hospitalized patients with neoplasia undergoing chemotherapy. Microorganisms, 11.","DOI":"10.3390\/microorganisms11102547"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3033","DOI":"10.1002\/cam4.2955","article-title":"Mortality and admission to intensive care units after febrile neutropenia in patients with cancer","volume":"9","author":"Aagaard","year":"2020","journal-title":"Cancer Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.3324\/haematol.2013.091025","article-title":"European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: Summary of the 2011 4th European Conference on Infections in Leukemia","volume":"98","author":"Averbuch","year":"2013","journal-title":"Haematologica"},{"key":"ref_4","first-page":"228","article-title":"Management and Preventive Measures for Febrile Neutropenia","volume":"43","author":"Lucas","year":"2018","journal-title":"Pharm. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"v252","DOI":"10.1093\/annonc\/mdq196","article-title":"Management of febrile neutropenia: ESMO Clinical Practice Guidelines","volume":"21","author":"Gill","year":"2010","journal-title":"Ann. Oncol."},{"key":"ref_6","unstructured":"National Comprehensive Cancer Network (2025, April 08). NCCN Clinical Practice Guidelines in Oncology: Bone Cancer. Version 1.2025. Available online: https:\/\/www.nccn.org\/guidelines\/guidelines-detail?category=3&id=1457."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1093\/cid\/cir073","article-title":"Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America","volume":"52","author":"Freifeld","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","unstructured":"Averbuch, D., Aguilar-Guisado, M., Akova, M., Baccelli, F., Blijlevens, N., Cordonnier, C., Garcia Vidal, C., Mikulska, M., Mu\u00f1oz, P., and Neofytos, D. (2025, April 06). Bacterial: Febrile Neutropenia\u2014Duration of Therapy\u2014New Drugs. Available online: https:\/\/www.ecil-leukaemia.com\/en\/resources\/resources-ecil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s43162-022-00154-4","article-title":"Use of cefepime, meropenem, or piperacillin\/tazobactam as initial treatment for febrile neutropenia in patients with hematological malignancy\u2014A real-life experience","volume":"34","author":"Karim","year":"2022","journal-title":"Egypt. J. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3038","DOI":"10.1200\/JCO.2000.18.16.3038","article-title":"The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients","volume":"18","author":"Klastersky","year":"2000","journal-title":"J. Clin. Oncol."},{"key":"ref_11","first-page":"20499361221138346","article-title":"Approach to fever in patients with neutropenia: A review of diagnosis and management","volume":"9","author":"Keck","year":"2022","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e563","DOI":"10.1016\/S2352-3026(22)00145-4","article-title":"Short versus extended treatment with a carbapenem in patients with high-risk fever of unknown origin during neutropenia: A non-inferiority, open-label, multicentre, randomised trial","volume":"9","author":"Sikkens","year":"2022","journal-title":"Lancet Haematol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1007\/s00520-013-2055-5","article-title":"Direct costs associated with febrile neutropenia in inpatients with hematological diseases in Singapore","volume":"22","author":"Zhou","year":"2014","journal-title":"Support. Care Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/oncolo\/oyac074","article-title":"Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?","volume":"27","author":"Boccia","year":"2022","journal-title":"Oncologist"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"87","DOI":"10.36519\/idcm.2022.141","article-title":"Factors Associated with Gram-Negative Bacteremia and Mortality in Neutropenic Patients with Hematologic Malignancies in a High-Resistance Setting","volume":"4","author":"Ayaz","year":"2022","journal-title":"Infect. Dis. Clin. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106919","DOI":"10.1016\/j.ijantimicag.2023.106919","article-title":"Prospective analysis of febrile neutropenia patients with bacteraemia: The results of an international ID\u2013IRI study","volume":"62","author":"Erdem","year":"2023","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"708.e1","DOI":"10.1016\/j.jtct.2023.08.013","article-title":"Early Antibiotic Deescalation and Discontinuation in Patients with Febrile Neutropenia after Cellular Therapy: A Single-Center Prospective Unblinded Randomized Trial","volume":"29","author":"Ram","year":"2023","journal-title":"Transplant. Cell. Ther."},{"key":"ref_18","first-page":"CD012184","article-title":"Early discontinuation of antibiotics for febrile neutropenia versus continuation until neutropenia resolution in people with cancer","volume":"1","author":"Stern","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.cmi.2022.08.007","article-title":"Shorter antibiotic courses in the immunocompromised: The impossible dream?","volume":"29","author":"Imlay","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e573","DOI":"10.1016\/S2352-3026(17)30211-9","article-title":"Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (How Long study): An open-label, randomised, controlled phase 4 trial","volume":"4","author":"Espigado","year":"2017","journal-title":"Lancet Haematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1080\/23744235.2018.1438649","article-title":"Early discontinuation of empirical antibacterial therapy in febrile neutropenia: The ANTIBIOSTOP study","volume":"50","author":"Talarmin","year":"2018","journal-title":"Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/00043426-200009000-00004","article-title":"Randomized Placebo-Controlled Trial of Oral Antibiotics in Pediatric Oncology Patients at Low-Risk With Fever and Neutropenia","volume":"22","author":"Klaassen","year":"2000","journal-title":"J. Pediatr. Hematol.\/Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s13756-020-00729-2","article-title":"Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome","volume":"9","author":"Niessen","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1093\/jac\/dkac190","article-title":"Safety and risk of febrile recurrence after early antibiotic discontinuation in high-risk neutropenic patients with haematological malignancies: A multicentre observational study","volume":"77","author":"Paret","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100855","DOI":"10.1016\/j.eclinm.2021.100855","article-title":"Stopping antibiotic therapy after 72 h in patients with febrile neutropenia following intensive chemotherapy for AML\/MDS (safe study): A retrospective comparative cohort study","volume":"35","author":"Schauwvlieghe","year":"2021","journal-title":"eClinicalMedicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.ijantimicag.2019.02.020","article-title":"Discontinuation of antimicrobial therapy in adult neutropenic haematology patients: A prospective cohort","volume":"53","author":"Berthon","year":"2019","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ishikawa, K., Masaki, T., Kawai, F., Ota, E., and Mori, N. (2023). Systematic Review of the Short-Term versus Long-Term Duration of Antibiotic Management for Neutropenic Fever in Patients with Cancer. Cancers, 15.","DOI":"10.3390\/cancers15051611"},{"key":"ref_28","unstructured":"Global Burden of Disease 2019 Cancer Collaboration (2022). Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol., 8, 420."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Walter, E. (2019). Regulatory and Economic Aspects in Oncology, Springer International Publishing. [1st ed.].","DOI":"10.1007\/978-3-030-01207-6"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e362","DOI":"10.1016\/S2352-3026(16)30062-X","article-title":"Economic burden of malignant blood disorders across Europe: A population-based cost analysis","volume":"3","author":"Burns","year":"2016","journal-title":"Lancet Haematol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1111\/j.1524-4733.2010.00740.x","article-title":"The Unit Costs of Inpatient Hospital Days, Outpatient Visits, and Daycare Treatments in the Fields of Oncology and Hematology","volume":"13","author":"Tan","year":"2010","journal-title":"Value Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/cid\/ciad605","article-title":"Is Short-Course Antibiotic Therapy Suitable for Pseudomonas aeruginosa Bloodstream Infections in Onco-hematology Patients With Febrile Neutropenia? Results of a Multi-institutional Analysis","volume":"78","author":"Feng","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ta\u015f, Z., Metan, G., Telli Dizman, G., Yavuz, E., Dizdar, \u00d6., B\u00fcy\u00fcka\u015f\u0131k, Y., Uzun, \u00d6., and Akova, M. (2024). An Institutional Febrile Neutropenia Protocol Improved the Antibacterial Treatment and Encouraged the Development of a Computerized Clinical Decision Support System. Antibiotics, 13.","DOI":"10.3390\/antibiotics13090832"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e20022","DOI":"10.1097\/MD.0000000000020022","article-title":"The cost-effectiveness of empirical antibiotic treatments for high-risk febrile neutropenic patients: A decision analytic model","volume":"99","author":"Tori","year":"2020","journal-title":"Medicine"},{"key":"ref_35","unstructured":"OECD (2025, March 14). OECD Health at a Glance 2023: OECD Indicators. Available online: https:\/\/www.oecd.org\/en\/publications\/health-at-a-glance-2023_7a7afb35-en.html."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/653\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:00:21Z","timestamp":1760032821000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/653"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["antibiotics14070653"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14070653","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2025,6,27]]}}}