Cohort Study of the Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia

Abstract

The time to antibiotic administration (TTA) has been proposed as a quality-of-care measure in febrile neutropenia (FN); however, few data regarding the impact of the TTA on the mortality of adult cancer patients with FN are available. The objective of this study was to determine whether the TTA is a predictor of mortality in adult cancer patients with FN. A prospective cohort study of all consecutive cases of FN, evaluated from October 2009 to August 2011, at a single tertiary referral hospital in southern Brazil was performed. The TTA was assessed as a predictive factor for mortality within 28 days of FN onset using the Cox proportional hazards model. Kaplan-Meier curves were used for an assessment of the mortality rates according to different TTAs; the log-rank test was used for between-group comparisons. In total, 307 cases of FN (169 subjects) were evaluated. During the study period, there were 29 deaths. In a Cox regression analysis, the TTA was independently associated with mortality within 28 days (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.10 to 1.26); each increase of 1 h in the TTA raised the risk of mortality within 28 days by 18%. Patients with FN episodes with a TTA of <30 min had lower 28-day mortality rates than those with a TTA of between 31 min and 60 min (3.0% versus 18.1%; log-rank P ‫؍‬ 0.0002). Early antibiotic administration was associated with higher survival rates in the context of FN. Efforts should be made to ensure that FN patients receive effective antibiotic therapy as soon as possible. A target of 30 min to the TTA should be adopted for cancer patients with FN.

Death and kidney allograft dysfunction after bacteremia

“…Invasive pneumococcal disease (IPD) in solid organ transplant recipients has a mortality rate of about 30 % [18], and PPV23 can reduce the odds ratio of IPD to 0.26, compared with placebo [19]. In FN, mortality rate was reduced when antibiotics were initiated within 30 min compared with more than 30-60 min after the onset of fever (3.0 vs. 18.1 %, respectively) [20]. Similar to sepsis, each hour of delay in the initiation of effective antibiotics led to an 18 % increase in the 28-day mortality risk [20].…”

“…In FN, mortality rate was reduced when antibiotics were initiated within 30 min compared with more than 30-60 min after the onset of fever (3.0 vs. 18.1 %, respectively) [20]. Similar to sepsis, each hour of delay in the initiation of effective antibiotics led to an 18 % increase in the 28-day mortality risk [20]. In addition, we consider that rituximab may induce earlyonset neutropenia in case 3 [21].…”

INTERNATIONAL PERSPECTIVE: Management of chemotherapy-induced febrile neutropenia among adult oncology patients: A review

“…Recently, Rosa and Goldani (2014) focused on the time of antibiotic administration and proposed quality-of-care measures in patients with CIFN. Few data regarding the impact of time in antibiotic administration on mortality of adult cancer patients with CIFN are available.…”

PERSPECTIVE INTERNATIONALE Gestion de la neutropénie fébrile induite par la chimiothérapie parmi des patients adultes en oncologie : recension de la documentation scientifique

“…Qui plus est, les chercheurs n'ont décelé aucun signe d'apparition d'une infection fongique invasive grave, même parmi les patients à risque élevé présentant des épisodes prolongés de neutropénie après la chimiothérapie. Récemment, Regis, Rosa et Goldani (2014) se sont penchés sur le moment de l'administration des antibiotiques et ont proposé des mesures de qualité des soins pour les patients pré-sentant une FNIC. Il existe peu de données sur l'impact du moment choisi pour l'administration des antibiotiques sur la mortalité de patients adultes atteints de cancer et de NFIC.…”