Effect of meropenem administration in extended infusion on the clinical outcome of febrile neutropenia: a retrospective observational study

J Antimicrob Chemother. 2014 Sep;69(9):2556-62. doi: 10.1093/jac/dku150. Epub 2014 May 22.


Objectives: Information on the efficacy of extended meropenem administration in neutropenic patients is scarce. Our objective was to determine whether the administration of meropenem in a 4 h extended infusion (EI) leads to a better clinical outcome in patients with febrile neutropenia than the conventional short infusion (SI).

Methods: This was a retrospective observational study. The subjects were neutropenic patients who presented with fever after receiving haematopoietic stem-cell transplantation or induction chemotherapy for acute myeloid leukaemia. The primary endpoint was the success of treatment after 5 days of meropenem therapy, defined as follows: the disappearance of fever leading to a maintained (≥ 24 h) feverless state; the resolution or improvement of the clinical signs and symptoms of infection; the absence of persistent or breakthrough bacteraemia; and no additional antibiotics prescribed because of an unsatisfactory clinical evolution.

Results: Eighty-eight patients received meropenem (1 g/8 h) in SI and 76 received the same dose in EI. Treatment success on day 5 was superior in the EI group [52/76 (68.4%) versus 36/88 (40.9%); P<0.001]. Meropenem administered in EI was independently associated with success (OR 3.13, 95% CI 1.61-6.10). Fewer additional antibiotics were prescribed in the EI group during the first 5 days of treatment [20/76 (26.3%) versus 44/88 (50.0%); P=0.002]. Using Kaplan-Meier survival analysis a more prompt defervescence and a faster decrease in C-reactive protein concentration were observed in the EI group (P=0.021 and P=0.037, respectively). There were no significant differences in the length of hospital stay and in the mortality rate.

Conclusions: Meropenem administration in EI results in a better clinical outcome for febrile neutropenia episodes, with fewer additional antibiotics needed.

Keywords: neutropenic fever; prolonged antibiotic infusion; β-lactams.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage*
  • Antineoplastic Agents / adverse effects
  • Febrile Neutropenia / drug therapy*
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Humans
  • Infusions, Intravenous / methods*
  • Leukemia, Myeloid, Acute / complications*
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Meropenem
  • Middle Aged
  • Retrospective Studies
  • Thienamycins / administration & dosage*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Antineoplastic Agents
  • Thienamycins
  • Meropenem