# Effect of Early Administration of Anti‐MRSA Drugs for Febrile Neutropenia in Allogeneic Hematopoietic Cell Transplantation

## TL;DR

Early use of anti-MRSA drugs in patients with febrile neutropenia after a bone marrow transplant may help reduce fever duration and lower the risk of complications in older patients.

## Contribution

This study provides evidence that early administration of anti-MRSA drugs improves fever resolution and reduces aGVHD risk in older allo-HCT patients.

## Key findings

- Early administration of anti-MRSA drugs was associated with shorter fever duration (p = 0.044).
- Late administration was linked to a lower chance of fever resolution by Day 7 (OR: 0.45).
- Older patients with late anti-MRSA drug use had increased aGVHD risk (HR: 2.22).

## Abstract

In febrile neutropenia (FN), the empirical use of anti‐methicillin‐resistant Staphylococcus aureus (MRSA) drugs is recommended, particularly when mucosal damage occurs during fluoroquinolone antibiotic administration. Therefore, the early use of anti‐MRSA drugs may be recommended in many cases of FN after allogeneic hematopoietic cell transplantation (allo‐HCT), but the evidence regarding their efficacy is limited.

To assess the impact of early administration of anti‐MRSA drugs on the resolution of fever in patients undergoing allo‐HCT.

We retrospectively analyzed 186 allo‐HCT patients. Patients receiving anti‐MRSA drugs within 3 days of fever onset formed the early‐decision group; those treated on or after Day 4 or untreated formed the late‐decision group.

The early group showed a significantly shorter fever duration than the late group. (p = 0.044). Multivariate logistic regression analysis showed the late group was negatively associated with fever resolution by Day 7 (OR: 0.45, 95% CI: 0.22–0.92, p = 0.028). No significant correlation was observed between anti‐MRSA drug timing and acute graft‐versus‐host disease (aGVHD) in the entire cohort. However, among patients aged 51 or older, the late group showed increased risk of aGVHD (HR: 2.22, 95% CI: 1.06–4.64, p = 0.034).

Associations were observed between the timing of anti‐MRSA drug administration and clinical outcomes in allo‐HCT, including fever resolution and the incidence of aGVHD in older patients.

The authors have confirmed clinical trial registration is not needed for this submission.