Outcomes in stable paediatric patients with cancer with fever and neutropenia according to time to antibiotic administration: a prospective observational study

Abstract

Purpose. To evaluate whether an increase in the time to antibiotics (TTA) administration in the paediatric emergency department worsens the prognosis of cancer patients with febrile neutropenia (FN) and a normal Paediatric Assessment Triangle (PAT) upon arrival. Methods. We describe patients with FN and a normal PAT upon arrival. We performed a subanalysis of a prospective, observational study conducted in two hospitals between November 2019 and October 2021. Poor outcome was defined as admission to the paediatric intensive care unit, development of sepsis or septic shock, acute complications, sequelae or death. Data were analysed using descriptive statistics. Results. We included 192 episodes involving a total of 163 patients. One hundred ten episodes (57.3%; 95% CI 50.0-54.4) had a TTA ≤ 60 minutes (short TTA) and 82 (42.7%; 95% CI 35.6–50.0) had a TTA > 60 minutes (long TTA). The median TTA administration in the short TTA group was 35 minutes (IQR 30–45), while in the long TTA group it was 100 minutes (IQR 65–120) (p < 0.001). Baseline characteristics were similar in both groups, except for previous episodes of FN: 71 (64.5%) in the short TTA group and seven (8.5%) in the long TTA group (p < 0.001). Twenty-two (11.5%) episodes resulted in a poor outcome, with no deaths and no differences between the two groups. Conclusions. Increased time to antibiotic administration in stable paediatric FN patients may not compromise clinical outcomes, thereby supporting the feasibility of a "wait and see" approach.