Time to antibiotics and outcomes in cancer patients with febrile neutropenia

Abstract

BackgroundFebrile neutropenia is an oncologic emergency. The timing of antibiotics administration in patients with febrile neutropenia may result in adverse outcomes. Our study aims to determine time-to- antibiotic administration in patients with febrile neutropenia, and its relationship with length of hospital stay, intensive care unit monitoring, and hospital mortality.MethodsThe study population was comprised of adult cancer patients with febrile neutropenia who were hospitalized, at a tertiary care hospital, between January 2010 and December 2011. Using Multination Association of Supportive Care in Cancer (MASCC) risk score, the study cohort was divided into high and low risk groups. A multivariate regression analysis was performed to assess relationship between time-to- antibiotic administration and various outcome variables.ResultsOne hundred and five eligible patients with median age of 60 years (range: 18–89) and M:F of 43:62 were identified. Thirty-seven (35%) patients were in MASCC high risk group. Median time-to- antibiotic administration was 2.5 hrs (range: 0.03-50) and median length of hospital stay was 6 days (range: 1–57). In the multivariate analysis time-to- antibiotic administration (regression coefficient [RC]: 0.31 days [95% CI: 0.13-0.48]), known source of fever (RC: 4.1 days [95% CI: 0.76-7.5]), and MASCC high risk group (RC: 4 days [95% CI: 1.1-7.0]) were significantly correlated with longer hospital stay. Of 105 patients, 5 (4.7%) died & or required ICU monitoring. In multivariate analysis no variables significantly correlated with mortality or ICU monitoring.ConclusionsOur study revealed that delay in antibiotics administration has been associated with a longer hospital stay.

Impact of time to antibiotics on outcomes of chemotherapy-induced febrile neutropenia

“…In addition, relatively small numbers of FN episodes were analyzed, making it more difficult to draw definite conclusions. More recently, Perron et al [17] reported the data of 105 patients with FN, showing a . Numbers and complication rates at hourly intervals from triage to antibiotics are shown using a histogram.…”

Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update

“…Data on time to antibiotic administration are sparse, although two relevant studies 14,15 were found during preparation for this update. Perron et al 14 found a significant association on multivariate analysis between time to administration (TTA) and length of hospital stay, but not mortality or ICU monitoring.…”

Critical review of emergency department management of chemotherapy complications in cancer patients

“…The time to commencement of antibiotics (AB) is critical in an oncologic emergency, where chemo‐related immunocompromised patients are at risk of being overwhelmed by neutropenic sepsis. Delays to commencement of AB have been shown to result in poorer clinical outcomes (Perron, Emara, & Ahmed, ).…”