Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer

Abstract

Background Time‐to‐antibiotic (TTA) administration is a widely used quality‐of‐care measure for children with cancer and febrile neutropenia (FN). We sought to determine whether TTA is associated with outcomes of FN. Procedure A single‐center, retrospective cohort study was conducted of 1,628 FN admissions from 653 patients from 2001 to 2009. Outcome variables included (1) an adverse event (AE) composite of in‐hospital mortality, pediatric intensive care unit (PICU) admission within 24 hours of presentation, and/or fluid resuscitation ≥40 ml/kg within 24 hours of presentation and (2) length of stay (LOS). TTA was measured as a continuous variable and in 60‐minute intervals. Mixed regression models were constructed to evaluate associations of TTA with the outcome variables after adjusting for relevant covariates including cancer diagnosis, degree of myelosuppression, and presence of bacteremia. Results The composite AE outcome occurred in 11.1% of admissions including 0.7% in‐hospital mortality, 4.7% PICU admission, and 10.1% fluid resuscitation. In univariate analysis, TTA was associated with the composite AE outcome (Odds Ratio [OR] 1.29, 95% CI 1.02–1.64) but not LOS. In multivariate analysis, after adjustment for relevant covariates, 60‐minute TTA intervals were associated with the composite AE outcome (61–120 minutes vs. ≤60 minutes, OR 1.81, 95% CI 1.01–3.26). Unexpectedly, admission from the emergency department (ED) was also independently associated with the composite AE outcome (ED vs. clinic, OR 3.15, 95% CI 1.95–5.09). Conclusions TTA and presentation to the ED are independently associated with poor outcomes of FN. Pediatr Blood Cancer 2013;60:1299–1306. © 2013 Wiley Periodicals, Inc.

Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

“…[11,15,16] A recently published study reported 11.1% composite AE outcome in FN patients with in-hospital mortality of (0.7%), PICU admission (4.7%), and fluid resuscitation > 40 ml/kg in (10.1%). [17] Out data also showed that severe myelosuppression was associated with composite AE outcome as patients with more severe neutropenia and thrombocytopenia have a higher risk for AE [13,21]. A diagnosis of sepsis or bacteremia conferred a 2.3-fold increase in the risk (13% vs. 29%; p=0.05) of composite AE.…”

Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias

“…Esto tiene una importancia enorme, ya que el retraso para la administración de los antimicrobianos se ha correlacionado con peor pronós-tico, mientras que el inicio rápido se ha relacionado con mejor pronóstico 9,10 . Sin embargo, a pesar de esfuerzos constantes para cumplir con esta cuota, se ha visto un alargamiento progresivo del tiempo para la administración de los antimicrobianos, tanto así que > 50% de los departamentos de emergencias en E.U.A.…”

“…Afortunadamente, está bien establecido que el tratamiento antimicrobiano oportuno disminuye la mortalidad por una infección bacteriana seria de forma considerable 9 . Por otro lado, el retraso para la administración de antimicrobianos se ha correlacionado con peor pronóstico 10 . Por estas razones, es de suma importancia que el mé-dico conozca bien el manejo del niño con cáncer que se presenta con fiebre al servicio de emergencias y en el que se documenta neutropenia en el hemograma.…”

Comparison of Efficacy of Piperacillin/Tazobactam Vs Cefoperazone/Sulbactam as Empirical Therapy in Patients with Febrile Neutropenia

“…[1] The signs and symptoms of inflammation and infection may be absent in these patients. Early empiric therapy [2][3][4] is imperative and may directly affect the clinical outcome during and after the illness. The time duration taken to start the patient on antibiotics has a correlation with the outcome.…”