Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study

Abstract

BackgroundInitial management of chemotherapy-induced febrile neutropaenia (FN) comprises empirical therapy with a broad-spectrum antimicrobial. Currently, there is sufficient evidence to indicate which antibiotic regimen should be administered initially. However, no randomized trial has evaluated whether adherence to an antimicrobial stewardship program (ASP) results in lower rates of mortality in this setting. The present study sought to assess the association between adherence to an ASP and mortality among hospitalised cancer patients with FN.MethodsWe conducted a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All adult patients who were admitted to the haematology ward with cancer and FN were followed up for 28 days. ASP adherence to the initial antimicrobial prescription was determined. The mortality rates of patients who were treated with antibiotics according to the ASP protocol were compared with those of patients treated with other antibiotic regimens. The multivariate Cox proportional hazards model and propensity score were used to estimate 28-day mortality risk.ResultsA total of 307 FN episodes in 169 subjects were evaluated. The rate of adherence to the ASP was 53%. In a Cox regression analysis, adjusted for propensity scores and other potential confounding factors, ASP adherence was independently associated with lower mortality (hazard ratio, 0.36; 95% confidence interval, 0.14–0.92).ConclusionsAntimicrobial selection is important for the initial management of patients with FN, and adherence to the ASP, which calls for the rational use of antibiotics, was associated with lower mortality rates in this setting.

Managing febrile neutropenia in adult cancer patients: an integrative review of the literature

“…This integrative review located a sample of 12 articles (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) which met the inclusion criteria and are presented in Chart 1.…”

“…Regarding the interventions for management of CT-induced FN, there was a prevalence of studies focused on pharmacological treatment (use of empiric ABT in hospital and outpatient settings, adherence to an antimicrobial management protocol and use of prophylactic or non-prophylactic growth factor) (14)(15)(18)(19)(20)(21)(22)(23)(24) and improvement in the diagnostics (association of biomarkers with the MASCC risk index) (17) . Only one study (16) investigated pharmaceutical management in relation to the efficacy of antibiotic dosage and a study which implied that nurses could contribute to the identification of elderly patients who would benefit from prophylactic use of growth factor in order to reduce the occurrence of FN (13) .…”

“…In another study, adherence to an antimicrobial management protocol enabled a reduction in the mortality rate (21) . When comparing efficacy between cefepime and ciprofloxacin, a study recommended that cefepime be used as the initial standard treatment of choice for FN and ciprofloxacin as an empiric and prophylactic treatment.…”

“…Data collection of primary articles (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) included in the integrative review was made possible through an instrument detailing: identification of the original article (title, periodical, authors, specialism of authors, year of publication); objective(s); methodological characteristics of the study (type, sample, specialism of the professionals involved in FN management); intervention for FN management; and main findings, conclusions and identification of limitations and/or biases. For the analysis and synthesis of these articles, we used synoptic tables (11) containing: title, author/year and professional category; interventions realized; results; and recommendations/conclusions.…”

“…To evaluate the association between adherence to an antimicrobial management protocol and the mortality of hospitalized NF patients (21) .…”