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Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia

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Abstract

Purpose

To determine if time to antibiotics (TTA) improves outcomes of hospital length of stay, admission to the intensive care unit, and 30-day mortality in adult patients with febrile neutropenia.

Methods

This retrospective cohort study evaluated the impact of time to antibiotic, in the treatment of febrile neutropenia, on hospital length of stay, admission to the intensive care unit, and 30-day mortality. Cases included were patients 18 years or older hospitalized with febrile neutropenia from August 1, 2006 to July 31, 2016. To adjust for other characteristics associated with hospital length of stay, admission to the intensive care unit, and 30-day mortality, a multivariate analysis was performed.

Results

A total of 3219 cases of febrile neutropenia were included. The median hospital length of stay was 7.0 days (IQR 4.1–13.3), rate of intensive care unit admission was 13.6%, and 30-day mortality was 6.6%. Multivariate analysis demonstrated time to antibiotics was not associated with hospital length of stay but was associated with admission to the intensive care unit admission and 30-day mortality. Delays in time to antibiotic of up to 3 hours did not impact outcomes.

Conclusions

A shorter time to antibiotic is important in treatment of febrile neutropenia; however, moderate delays in antibiotic administration did not impact outcomes. Further investigation is needed in order to determine if other indicators of infection, in addition to fever, or other supportive management, in addition to antibiotics, are indicated in the early identification and management of infection in patients with neutropenia.

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Abbreviations

ACE:

Advanced Cohort Explorer

ANC:

Absolute neutrophil count

EMR:

Electronic medical record

ICU:

Intensive care unit

IDSA:

Infectious Disease Society of America

LOS:

Length of stay

MASCC:

Multinational Association for Supportive Care in Cancer

TTA:

Time to antibiotic

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Author information

Authors and Affiliations

  1. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, 5665 Peachtree Dunwoody Rd, Atlanta, GA, 30342, USA

    Lisa M. Daniels

  2. Division of Hematology, Division of Medical Oncology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Urshila Durani

  3. Department of Pharmacy, Mayo Clinic Rochester, Rochester, MN, USA

    Jason N. Barreto

  4. Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA

    John C. O’Horo & Pritish K. Tosh

  5. Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Mustaqeem A. Siddiqui

  6. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    John G. Park

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  1. Lisa M. Daniels
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  2. Urshila Durani
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Corresponding author

Correspondence to Lisa M. Daniels.

Ethics declarations

We obtained Institutional Review Board approval at Mayo Clinic (Rochester, MN) to use the existing electronic medical record (EMR) of patients that have given previous authorization for research (IRB 15-006458).

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The authors declare that they have no conflict of interest.

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Daniels, L.M., Durani, U., Barreto, J.N. et al. Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia. Support Care Cancer 27, 4171–4177 (2019). https://doi.org/10.1007/s00520-019-04701-8

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  • DOI: https://doi.org/10.1007/s00520-019-04701-8

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