Comparison of vancomycin and teicoplanin for febrile neutropenia following hematopoietic stem cell transplantation.

Febrile neutropenia is a common complication of hematopoietic stem cell transplantation. Although anti-MRSA agents such as vancomycin and teicoplanin are widely used for treatment, their clinical efficacy and safety during the early post-transplant period remain unclear. In this study, we retrospectively compared the shortterm mortality and safety of vancomycin and teicoplanin in patients with febrile neutropenia during the early post-transplantation period. This study analyzed patients who received vancomycin or teicoplanin injections for febrile neutropenia within 30 days of hematopoietic stem cell transplantation at the National Cancer Center Hospital between January 2014 and December 2016. Blood concentrations, clinical efficacy, and safety were evaluated. The proportion of patients who achieved the effective target concentration in the first measurement was significantly higher in the teicoplanin group than in the vancomycin group (79.2% vs. 35.3%, P < 0.01). The teicoplanin group reached the target concentration more rapidly (3.0 days vs. 4.5 days, P = 0.04). The all-cause mortality within 90 days of initiating anti-MRSA treatment was significantly lower in the teicoplanin group (1.0% vs. 9.8%, P = 0.01), as was the incidence of renal dysfunction (1.0% vs. 27.4%, P < 0.01). In the vancomycin group, renal dysfunction was significantly more frequent after concomitant tazobactam/piperacillin treatment (50.0% vs. 12.9%, P < 0.01). Breakthrough gram-positive cocci infections occurred only in the teicoplanin group (2.0%), with MR- <i>Staphylococcus haemolyticus</i> identified in all cases. Teicoplanin reached effective concentrations more efficiently than vancomycin, with a lower incidence of renal dysfunction and improved short-term outcomes in early post-transplant febrile neutropenia.