Treatment of community-onset pneumonia in neutropenic cancer patients: β-lactam monotherapy versus combination antibiotic regimens

• Published in: Pneumonia 2019-06, Vol.11 (1), p.2-7, Article 2
• Main Authors: Seok, Hyeri, Ko, Jae-Hoon, Peck, Kyong Ran, Kim, Ji-Yeon, Lee, Ji Hye, Park, Ga Eun, Cho, Sun Young, Kang, Cheol-In, Lee, Nam Yong, Chung, Doo Ryeon
• Format: Article
• Language: English
• Subjects: Antibiotics; Antigens; Brief Report; Cancer; Cancer therapies; Chemotherapy; Combination antibiotic regimens; Febrile neutropenia; Fever; Hospitals; Lymphoma; Mortality; Multiple myeloma; Neutropenia; Neutrophils; Pathogens; Pneumonia; Streptococcus infections
• ISSN: 2200-6133; 2200-6133
• DOI: 10.1186/s41479-019-0061-1

Although β-lactam monotherapy may be sufficient in non-critically ill patients with community-acquired pneumonia, the value of combination antibiotic regimens in community-onset neutropenic pneumonia remains unclear. A retrospective cohort study was conducted to compare the effects of combination antibiotic regimens to those of β-lactam monotherapy in cancer patients with community-onset neutropenic pneumonia. Electronic medical records of patients diagnosed with community-onset neutropenic pneumonia between March 1995 and February 2015 at a tertiary care center were reviewed. During the study period, 165 cancer patients with community-onset neutropenic pneumonia were identified. Seventy-two patients received β-lactam monotherapy and 93 received combination therapy (β-lactam plus either a macrolide or fluoroquinolone). Causative pathogens were identified in 27.9% of the patients, and only two were positive for atypical pathogens. Although 30-day mortality was higher in the β-lactam group (15.3% versus 4.3%;  = 0.015), combination therapy was not associated with a statistically significant survival benefit in the multivariate analysis (hazard ratio 0.85, 95% confidence interval 0.20-3.67;  = 0.827). Duration of neutropenia, C-reactive protein level, and Multinational Association for Supportive Care in Cancer risk index were significant factors for 30-day mortality. In a subgroup analysis of patients treated with cefepime, the most frequently used β-lactam (63.0%), combination therapy also showed no significant survival benefit. Combination antibiotic regimens were not associated with a survival benefit over β-lactam monotherapy in the treatment of community-onset neutropenic pneumonia. Unnecessary combination therapy should be reconsidered in cancer patients who are at high risk for adverse drug reactions and colonization with multi-drug resistant organisms.