Prevention and management of febrile neutropenia in acute myeloid leukaemia and higher risk myelodysplastic syndrome: An international survey of current practice

Febrile neutropenia causes substantial morbidity in acute myeloid leukaemia and higher risk myelodysplastic syndrome. We aimed to describe current practice and priorities for clinical trials in the prevention and management of febrile neutropenia across Australia/New Zealand (ANZ), the United Kingdom (UK), Canada and Europe. We performed an international survey of haematologists recruited via professional networks. Eighty-five unique hospitals were represented (ANZ = 20; Canada = 14; UK = 30; Europe = 21). Antibacterial prophylaxis was more commonly prescribed in Canada (79%) and the UK (83%) than in ANZ (30%) and Europe (48%, p < 0.001), and was prescribed more frequently to outpatients than inpatients. The most common empiric treatment was piperacillin-tazobactam monotherapy (66/84, 79%), with nurse-initiated antibiotic orders used in 35/84 (42%). Screening for multidrug-resistant organisms varied and was not usually used to direct antibiotic treatment. Antibiotic de-escalation was attempted in most institutions; for uncomplicated short-lived fever of unknown source, 39/85 (46%) reported ceasing antibiotics at 72 h and 68/85 (80%) within 7 days. For patients with bacteraemia, de-escalation strategies included narrowing spectrum, oral switch and cessation after defined duration. Most respondents (79/85, 93%) reported interest in recruiting for clinical trials. Clinical trials addressing practice variability in febrile neutropenia are needed, and are supported by haematologists.