Febrile neutropenia is a common complication in oncohematological patients who, for example, have just received chemotherapy treatment or a hematopoietic stem cell transplant. It is a heterogeneous clinical picture and the initial suspicion is that it is caused by an infection that, in these immunocompromised patients, can end up being fatal. That is why it is treated as an emergency: in the event of a case of febrile neutropenia, antibiotics must be administered as quickly as possible. Beta-lactams are the treatment of choice and it is necessary to ensure that the concentration of antibiotics in the blood remains at sufficiently high levels, above the minimum inhibitory concentration (MIC), for as long as possible. One way to provide a consistent antibiotic concentration over time is to use extended or prolonged infusions, rather than intermittent ones. Until now, evidence for its efficacy and safety in this field was very scarce and came mainly from observational studies. 

Now, the results of a multicenter clinical trial carried out in four state centers and recently published in Clinical Microbiology and Infection provide more information on the subject. The authors, members of the IDIBELL research group on respiratory infections and immunocompromised host at IDIBELL, from the Infectious Diseases, Microbiology and Pharmacy Service of the Bellvitge University Hospital and professionals from the Catalan Institute of Oncology and the University of Barcelona, have analyzed a group of 150 patients undergoing hematopoietic stem cell transplantation or chemotherapy for acute leukemia who required empirical antibiotic treatment for febrile neutropenia. They were randomly separated into two groups and one received antibiotics in extended infusion, while the others followed the conventional method. The results have shown no significant differences between the two groups either in terms of therapeutic success, adverse events or mortality at 30 days. However, it was possible to demonstrate that extended perfusion manages to maintain beta-lactam concentrations above the MIC for a longer time than conventional administration. 

The leader of the study, Dr. Carlota Gudiol, researcher at IDIBELL, Bellvitge Hospital and ICO, believes that “the results of this trial do not support the use of widespread infusion of beta-lactam antibiotics in the routine management of patients with febrile neutropenia, but it could be a useful strategy in cases with infections caused by microorganisms less sensitive to beta-lactam antibiotics. Still, more studies are needed to be able to prove it”. 

The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research centre created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of Hospitalet de Llobregat.

IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish centres accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Centre of the AECC Scientific Foundation (FCAECC).