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Open Access Highly Accessed Research article

Time to antibiotics and outcomes in cancer patients with febrile neutropenia

Thomas Perron1, Mohamed Emara2 and Shahid Ahmed1234*

Author Affiliations

1 Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada

2 Saskatoon Cancer Center, Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon, SK, Canada

3 Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada

4 Department of Medicine, Site Leader for Gastrointestinal Cancer, Saskatoon Cancer Center, University of Saskatchewan, 20 Campus Drive, Saskatoon, SK S7N4H4, Canada

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BMC Health Services Research 2014, 14:162  doi:10.1186/1472-6963-14-162

Published: 10 April 2014

Abstract

Background

Febrile neutropenia is an oncologic emergency. The timing of antibiotics administration in patients with febrile neutropenia may result in adverse outcomes. Our study aims to determine time-to- antibiotic administration in patients with febrile neutropenia, and its relationship with length of hospital stay, intensive care unit monitoring, and hospital mortality.

Methods

The study population was comprised of adult cancer patients with febrile neutropenia who were hospitalized, at a tertiary care hospital, between January 2010 and December 2011. Using Multination Association of Supportive Care in Cancer (MASCC) risk score, the study cohort was divided into high and low risk groups. A multivariate regression analysis was performed to assess relationship between time-to- antibiotic administration and various outcome variables.

Results

One hundred and five eligible patients with median age of 60 years (range: 18–89) and M:F of 43:62 were identified. Thirty-seven (35%) patients were in MASCC high risk group. Median time-to- antibiotic administration was 2.5 hrs (range: 0.03-50) and median length of hospital stay was 6 days (range: 1–57). In the multivariate analysis time-to- antibiotic administration (regression coefficient [RC]: 0.31 days [95% CI: 0.13-0.48]), known source of fever (RC: 4.1 days [95% CI: 0.76-7.5]), and MASCC high risk group (RC: 4 days [95% CI: 1.1-7.0]) were significantly correlated with longer hospital stay. Of 105 patients, 5 (4.7%) died & or required ICU monitoring. In multivariate analysis no variables significantly correlated with mortality or ICU monitoring.

Conclusions

Our study revealed that delay in antibiotics administration has been associated with a longer hospital stay.

Keywords:
Time to antibiotic; Febrile neutropenia; Length of stay; Outcome; Hospital mortality