Improving the emergency department management of post-chemotherapy sepsis in haematological malignancy patients

Ko, Hiu Fai; Tsui, S S; Tse, Johnson Wai Keung; Kwong, Wing Yan; Chan, Otto; Wong, Gordon C K

doi:10.12809/hkmj144280

Cited by 8 publications

(17 citation statements)

References 15 publications

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“…1. Thirty studies were included, thirteen in adult [12,[20][21][22][23][24][25][26][27][28][29][30][31], and seventeen in pediatric patients [16,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47], including a total of 1891 and 6820 FN episodes, respectively. Two-third of the studies were undertaken in the USA (n = 20; 67%).…”

Section: Overviewmentioning

confidence: 99%

“…Safety Most studies were underpowered to address safety (mortality, ICU admission, or occurrence of severe sepsis). Number of deaths was reported by eleven studies [16,24,25,31,33,35,36,39,42,43,46], with a median mortality of 0% (maximum 39%) before and median mortality of 0% (maximum 6%) after the intervention. No significant differences of mortality before and after intervention were detected in seven of these 11 studies.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…One study only reported the overall number of deaths [43]. One study [25] found an increase in mortality from 0 (0/19 episodes) to 6% (3/50 episodes; p < 0.05), but these are equally low numbers of deaths and no significant difference was found when death was included into a composite outcome together with serious medical complications (1/19 versus 7/50; p = 0.45). A decrease in mortality was shown in two studies [31,42].…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…In their study, ICU admission and septic shock were as well significantly reduced after the implementation, 9.4 to 2.9% (p = 0.016) and 10.9 to 3.5% (p = 0.011), respectively. Numbers of ICU admissions were reported by eight studies [24,25,33,35,36,39,42,46], with a median of 5% (maximum 9%) before and a median of 1.3% (maximum 7%) after the intervention. Only one study [16] found a difference in need for ICU admission before and after the intervention (34% versus 12.8%; p < 0.05).…”

Section: Clinical Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Koenig

Schneider

Morgan

et al. 2019

Support Care Cancer

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Purpose Multiple interventions have been developed aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia (FN) following chemotherapy for cancer. We evaluated their effect to reduce TTA and their impact on important clinical outcomes in a systematic review. Methods The search covered seven databases. Biases and quality of studies were assessed with the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Interventions could be implemented in any setting and performed by any person included in the FN management. Absolute change of TTA was the primary outcome. Registration: PROSPERO (CRD42018092948). Results Six thousand two hundred ninety-six titles and abstracts were screened, 177 studies were retrieved and 30 studies were included. Risk of bias was moderate to serious in 28 studies and low in two studies. All but one study reported a reduction of TTA after the intervention. Various types of interventions were implemented; they most commonly aimed at professionals. Most of the studies made more than one single intervention. Conclusion This review may help centers to identify their specific sources of delay and barriers to change and to define what intervention may be the best to apply. This review supports the assertion that TTA can be considered a measure of quality of care, emphasizes the importance of education and training, and describes the very different interventions which have effectively reduced TTA.

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Section: Overviewmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Koenig

Schneider

Morgan

et al. 2019

Support Care Cancer

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“…Another study showed that inability to achieve early resuscitation goals (OR: 1.94, 95% CI: 1.0-3.51) was associated with increased 28-day mortality rate (102). Thus, prompt initiation of EGDT is still recommended for septic shock (103)(104)(105)(106)(107)(108), and many efforts have been made to improve early recognition and treatment of septic shock (109). However, early recognition of severe sepsis and septic shock, albeit crucial for EGDT efficacy, remains elusive in clinical practice.…”

Section: The Importance Of Early Recognition Of Sepsismentioning

confidence: 99%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

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Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

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Predicting Neutropenic Sepsis in Patients with Hematologic Malignancy: A Retrospective Case–Control Study

Lee,

Kim

2024

Clin Nurs Res

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Neutropenic sepsis (NS) is one of the leading causes of death among patients with hematologic malignancies. Identifying its predictive factors is fundamental for early detection. Few studies have evaluated the predictive factors in relation to microbial infection confirmation, which is clinically important for initiating sepsis treatment. This study aimed to determine whether selected biomarkers (i.e., body temperature, C-reactive protein, albumin, procalcitonin), treatment-related characteristics (i.e., diagnosis, duration of neutropenia, treatment modality), and infection-related characteristics (i.e., infection source, causative organisms) can predict NS in patients with hematologic malignancies. We also aimed to identify the optimal predictive cutoff points for these parameters. This retrospective case–control study used the data from a total of 163 patients (58 in the sepsis group and 105 in the non-sepsis group). We collected data with reference to the day of specimen collection, with which microbial infection was confirmed. Multiple logistic regression was used to determine predictive risk factors and the area under the curve (AUC) of the receiver operating characteristic for the optimal predictive cutoff points. The independent predictors of NS were average body temperature during a fever episode and procalcitonin level. The odds for NS rose by 9.97 times with every 1°C rise in average body temperature (95% confidence interval, CI [1.33, 75.05]) and by 2.09 times with every 1 ng/mL rise in the procalcitonin level (95% CI [1.08, 4.04]). Average body temperature (AUC = 0.77, 95% CI [0.68, 0.87]) and procalcitonin levels (AUC = 0.71, 95% CI [0.59, 0.84]) have fair accuracy for predicting NS, with the optimal cutoff points of 37.9°C and 0.55 ng/mL, respectively. This study found that average body temperature during a fever episode and procalcitonin are useful in predicting NS. Thus, nurses should carefully monitor body temperature and procalcitonin levels in patients with hematologic malignancies to detect the onset of NS.

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Improving the emergency department management of post-chemotherapy sepsis in haematological malignancy patients

Cited by 8 publications

References 15 publications

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

Predicting Neutropenic Sepsis in Patients with Hematologic Malignancy: A Retrospective Case–Control Study

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