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Title: Urine cultures at the onset of febrile neutropenia rarely impact antibiotic management in asymptomatic adult cancer patients.
Austin Authors: Grigg, Samuel E ;Date, Patrick;Loh, Zoe ;Estacio, Ortis;Johnson, Douglas F;Hawkes, Eliza A ;Grigg, Andrew P 
Affiliation: Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
University of Melbourne, Parkville, Victoria, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 27-Sep-2018 2018-09-27
Publication information: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2018; online first: 27 September
Abstract: There is a paucity of data regarding the utility of routine urine cultures in adults with febrile neutropenia (FN) without urinary symptoms receiving protocolised antibiotics. This is reflected by inconsistent recommendations in international and regional FN guidelines. We addressed this issue by retrospectively reviewing the impact of routine urine cultures on antibiotic management in haematology cancer inpatients at a tertiary hospital. All haematology inpatients over a 5-year period (2011-2015) were retrospectively reviewed for episodes of FN (neutrophil count < 0.5 × 109/L and fever > 37.5 °C). For each episode, demographic data, urinary tract symptoms and signs (absence of which was termed 'asymptomatic'), urinalysis and urine culture results, antibiotic therapy and duration, and patient outcomes were collected. A urine culture was considered positive if > 105 colony forming units (CFU)/L were detected. Empiric antibiotic therapy for FN consisted of intravenous piperacillin/tazobactam in stable patients, with the addition of vancomycin and a single dose of gentamicin if systemically compromised. Four hundred and thirty-three episodes of FN were identified in 317 patients. Urine cultures were performed in 362 (84%) episodes. Cultures were positive in 9 of 48 (19%) symptomatic episodes versus 8 of 314 (2.5%) asymptomatic episodes (RR = 7.4, p < 0.0001). A change in antibiotic management due a positive urine culture occurred in only 5 episodes (1.4%): 3 of 48 (6.3%) symptomatic and 2 of 314 (0.6%) asymptomatic episodes respectively (RR = 9.8, p = 0.01). Routine urine cultures in FN patients without urinary symptoms who are already receiving protocolised broad spectrum antibiotics rarely impact subsequent antibiotic management.
DOI: 10.1007/s00520-018-4476-7
ORCID: 0000-0001-5743-3171
PubMed URL: 30259115
Type: Journal Article
Subjects: Antibiotics
Febrile neutropenia
Haematological malignancy
Urine culture
Appears in Collections:Journal articles

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