Reducing Time to Antibiotic Administration for Febrile Neutropenia in the Emergency Department

Keng, Michael; Thallner, Elaine; Elson, Paul; Ajon, Christine; Sekeres, Jennifer; Wenzell, Candice M.; Seastone, David J.; Gallagher, Erika M.; Weber, Catherine; Earl, Marc; Mukherjee, Sudipto; Pohlman, Brad; Cober, Eric; Foster, Virginia B.; Yuhas, Joy; Kalaycio, Matt; Bolwell, Brian J.; Sekeres, Mikkael A.

doi:10.1200/jop.2014.002733

Cited by 52 publications

(40 citation statements)

References 24 publications

(31 reference statements)

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“…A recent paper by Keng et al () described a prospective study. They implemented a febrile neutropenic pathway (FNP) which incorporated a triage reclassification of FN to the same level as myocardial infarction, private waiting rooms for FN patients, standardisation of the FN definition across the hospital, a FN alert card, a FN order set, a protocol for AB administration before confirmation of neutropenia, FNP AB available in ED Pyxis machines and FNP training for the ED and cancer centre staff.…”

Section: Resultsmentioning

confidence: 99%

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

Blanco

2018

Eur J Cancer Care

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Introduction Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy‐related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care. Methods This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines. Results The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross‐sectional case–control studies and randomised control trials. Conclusion All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.

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Section: Resultsmentioning

confidence: 99%

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

Blanco

2018

Eur J Cancer Care

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“…But, the benefit of reducing the timing of antimicrobial initiation is uncertain. While some studies showed that shortening the time of antibiotic administration significantly reduced the length of hospital stay [2,3], serious complications [4], ICU admission and 30-day mortality [7,18], others failed to demonstrate any benefit with regard to the length of hospital stay [5] or serious complication [6]. In patients admitted to the ICU with severe sepsis or septic shock, mortality was higher when antimicrobial initiation exceeded 1 hour after the first sign of sepsis [19] or 2 hours after ICU admission [20].…”

Section: Discussionmentioning

confidence: 99%

“…Febrile neutropenia was one of these topics of prime interest, particularly the identification of optimal treatment strategies, including the effects of the timing of initial antibiotic therapy, biomarkers and early risk-stratification tools. The benefit of reducing the time of antibiotic initiation in the emergency department (ED) for neutropenic patients is controversial [2][3][4][5][6][7]. Moreover, research on the impact of the antibiotic adherence to international guidelines [8,9] in the ED is scarce [10].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department

et al. 2020

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OPEN ACCESS Citation: Peyrony O, Gerlier C, Barla I, Ellouze S, Legay L, Azoulay E, et al. (2020) Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department. PLoS ONE 15(2): e0229828. https://doi.org/ 10.Conversely, an inadequate ED antibiotic regimen was associated with higher ICU admission or death during hospital stay (OR = 3.50; 95% CI = 1.49 to 8.28). ConclusionAn inadequate ED antibiotic regimen in patients with FN was significantly associated with higher ICU admission or death during hospital stay.

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“…Azacytidine and decitabine target DNA methyltransferases, the enzymes responsible for promoter hypermethylation [1, 5]. However, their poor aqueous stability limits their administration to parenteral dosing.…”

Section: Introductionmentioning

confidence: 99%

LC–MS/MS assay for the quantitation of FdCyd and its metabolites FdUrd and FU in human plasma

Holleran

Eiseman

Parise

et al. 2016

Journal of Pharmaceutical and Biomedical Analysis

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The hypomethylating agent 5-fluoro-2′-deoxycytidine (FdCyd, NSC 48006) is being evaluated clinically both via the intravenous route and via the oral route in combination with 3,4,5,6-tetrahydrouridine (THU), a potent inhibitor of FdCyd catabolism. To determine the pharmacokinetics of FdCyd and downstream metabolites, we developed and validated an LC-MS/MS assay for the quantitation of FdCyd, 5-fluoro-2′-deoxyuridine (FdUrd), and 5-fluorouracil (FU) in 0.2 mL human plasma. After acetonitrile protein precipitation, the sample was split and separate chromatography was achieved for FdCyd with a Synergi Polar-RP column and for FdUrd and FU with a Shodex Asahipak NH2P-50 2D column. Gradients of 0.1% acetic acid in acetonitrile and water were used. Detection with a Quattromicro quadrupole mass spectrometer with electrospray ionization in positive-ion (FdCyd) or negative-ion (FdUrd and FU) multiple reaction monitoring (MRM) mode. The assay was linear from 5–3000 ng/mL for all three analytes and proved to be accurate (96.7–105.5%) and precise (<8.1%CV), and fulfilled FDA criteria for bioanalytical method validation. We demonstrated the suitability of this assay for measuring FdCyd and metabolites FdUrd and FU in plasma from a patient who was administered 120 mg PO FdCyd 30 min after 3000 mg THU. Our LC-MS/MS assay will be an essential tool to further define the pharmacology of FdCyd in ongoing and future studies.

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Reducing Time to Antibiotic Administration for Febrile Neutropenia in the Emergency Department

Abstract: The ED FNP is a significant quality initiative with sustainable interventions, and was able to demonstrate value by decreasing TTA compared to both historical and DA controls in cancer patients presenting to the ED.

Cited by 52 publications

References 24 publications

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

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

Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department

LC–MS/MS assay for the quantitation of FdCyd and its metabolites FdUrd and FU in human plasma

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