ANALYSIS OF THE VALUE OF EMPIRIC VANCOMYCIN ADMINISTRATION IN FEBRILENEUTROPENIA OCCURRING AFTER AUTOLOGOUS PERIPHERAL-BLOOD STEM-CELL TRANSPLANTS

We conducted a retrospective review of 125 patients undergoing high-do se therapy and stem cell rescue in order to evaluate the incidence of documented infection and the utility of the administration of vancomyc in empirically. All patients received prophylactic oral quinolone ther apy, Because neutropenia in this setting is relatively brief, 21 patie nts never manifested fever, and no patient died of infection. Of the r emaining 104 patients, positive blood cultures were obtained in only 1 0, nine with a gram stain positive and one with a gram stain negative organism. Sixty-two patients without any evidence of gram positive inf ection received vancomycin according to the existing algorithm for car e of neutropenic fevers. In this population of patients, empiric admin istration of vancomycin for neutropenic fevers without culture documen tation appears to be unnecessary, could be discontinued safely and at substantial cost savings, and might slow the appearance of vancomycin- resistant organisms.