Adherence to practice guidelines for the management of febrile neutropenia in patients undergoing hematopoietic stem cell transplantation: An observational study in a referral center in Iran

Abstract

Introduction Patients undergoing hematopoietic stem cell transplantation (HSCT) are suspected to develop febrile neutropenia (FN) and severe infections. Therefore, appropriate prescription of antibiotics in these patients is crucial to reduce the rates of morbidity, mortality, and antimicrobial resistance. The present study aimed to evaluate the physicians’ prescription and adherence to the FN clinical guidelines among patients undergoing HSCT. Methods This prospective observational single-center study was conducted during a 15-month period in a tertiary referral hospital in Iran. The patients with at least one episode of FN following HSCT were included in the current study. The physicians’ adherence to the Infectious Diseases Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) clinical guidelines for the management of FN was evaluated using prescription data and medical record reviews. Results Two hundred and fifteen patients with 297 FN episodes were evaluated. The timing of antibiotics and the selection of the initial regimen were considered guideline-based therapy. However, antibiotic dosing and initial regimen modification were not followed in terms of the guideline recommendations in 58.1% of the patients. In particular, vancomycin was inappropriately given in 83.1% of patients. The overall adherence of physicians to the guidelines was 35.8%. Conclusion Non-adherence to clinical guidelines is high particularly in initial regimen modification and administration of vancomycin, which affects hospital stay and patient's outcome. Implementation of guideline-review sessions to raise the awareness of the physicians and to improve the rational use of antimicrobial agents may be crucial.

Evaluation and management of febrile neutropenia in patients with cancer

“…[7][8][9] For example, a 2023 observational study found that antibiotic dosing and initial regimen recommendations were not followed in almost 60% of patients with febrile neutropenia who were undergoing hematopoietic stem cell transplantation. 10 T he American Cancer Society expects more than 2 million patients to receive a new cancer diagnosis in 2024. 1 The initial manifestations of malignancy, disease progression, and adverse reactions to treatment represent a significant disease burden, accounting for an estimated 4 million ED visits each year.…”

“…Recent studies report poor adherence to guidelines for risk assessment and management of patients with febrile neutropenia and cancer 7-9. For example, a 2023 observational study found that antibiotic dosing and initial regimen recommendations were not followed in almost 60% of patients with febrile neutropenia who were undergoing hematopoietic stem cell transplantation 10. Another 2020 observational study found that guideline adherence was merely 0.4% in low-risk patients 11.…”