ABSTRACT Background 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. Objectives To assess the impact of early administration of anti‐MRSA drugs on the resolution of fever in patients undergoing allo‐HCT. Methods 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. Results 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). Conclusions 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. Trial registration The authors have confirmed clinical trial registration is not needed for this submission.
Akaogi et al. (Sun,) studied this question.