Febrile neutropenia (FN) is a common serious complication in patients undergoing hematopoietic stem cell transplantation (HSCT) requiring urgent evaluation and initiation of empiric broad spectrum antibiotics (BSA). The appropriate duration of BSA for FN in patients with negative cultures and no identifiable infection remains undefined. We retrospectively analyzed allogenic and autologous HSCT patients with FN and negative infectious work-up at our facility from 2012 to 2018. The early de-escalation group (EDG) included those who had BSA de-escalation to fluoroquinolone prophylaxis at least 24 h prior to absolute neutrophil count (ANC) recovery after the patient was fever-free for at least 48 h. Among 297 patients undergoing their first HSCT who experienced FN with negative infectious work-up, 83 patients were de-escalated early with the remaining 214 in the standard of care group (SCG) whose BSA were continued until ANC was > 500. Duration of broad-spectrum antibiotics was shorter in EDG compared to SCG (3.86 days vs. 4.62 days, p = 0.03). Rates of mortality, new infections, and clinical decompensation requiring intensive care unit transfer and/or pressor use within 30 days were all similar between the two groups (0% vs. 0.4% p = 1.00, 0% vs. 1.4% p = 0.56, 13.2% vs. 8.4% p = 0.27). This indicates that it is safe to de-escalate antibiotics prior to ANC recovery, leading to less BSA exposure.

发热性中性粒细胞减少症 (FN) 是接受造血干细胞移植 (HSCT) 的患者常见的严重并发症，需要紧急评估并开始经验性广谱抗生素 (BSA)。对于培养阴性且没有可识别感染的患者，BSA 治疗 FN 的适当持续时间仍不确定。我们回顾性分析了 2012 年至 2018 年在我们机构进行 FN 且感染检查阴性的同种异体和自体 HSCT 患者。早期降级组 (EDG) 包括在治疗前至少 24 小时接受 BSA 降级至氟喹诺酮预防的患者。患者无发烧至少 48 小时后，绝对中性粒细胞计数 (ANC) 恢复。在 297 名接受首次 HSCT 且感染性检查阴性的 FN 患者中，83 名患者提前降级，其余 214 名患者属于标准护理组 (SCG)，其 BSA 持续直至 ANC > 500。 - EDG 中的抗生素谱比 SCG 中的时间更短（3.86 天 vs. 4.62 天，p  = 0.03）。两组之间的死亡率、新发感染率以及需要在 30 天内转入重症监护病房和/或使用升压药的临床失代偿率均相似（0% vs. 0.4% p = 1.00，0% vs.  1.4% p  = 0.56 ，13.2% 与 8.4% p  = 0.27）。这表明在 ANC 恢复之前降低抗生素剂量是安全的，从而减少 BSA 暴露。