Abstract
AbstractFever in neutropenia (FN) remains an unavoidable, potentially lethal complication of chemotherapy. Timely administration of empirical broad-spectrum intravenous antibiotics has become standard of care. But the impact of time to antibiotics (TTA), the lag period between recognition of fever or arrival at the hospital to start of antibiotics, remains unclear. Here we aimed to analyze the association between TTA and safety relevant events (SRE) in data from a prospective multicenter study. We analyzed the association between time from recognition of fever to start of antibiotics (TTA) and SRE (death, admission to intensive care unit, severe sepsis and bacteremia) with three-level mixed logistic regression. We adjusted for possible triage bias using a propensity score and stratified the analysis by severity of disease at presentation with FN. We analyzed 266 FN episodes, including 53 (20%) with SRE, reported in 140 of 269 patients recruited from April 2016 to August 2018. TTA (median, 120 min; interquartile range, 49–180 min) was not associated with SRE, with a trend for less SREs in episodes with longer TTA. Analyses applying the propensity score suggested a relevant triage bias. Only in patients with severe disease at presentation there was a trend for an association of longer TTA with more SRE. In conclusion, TTA was unrelated to poor clinical outcome in pediatric patients with FN presenting without severe disease. We saw strong evidence for triage bias which could only be partially adjusted.
Funder
Swiss Cancer League
Berner Stiftung für krebskranke Kinder
Publisher
Springer Science and Business Media LLC
Reference33 articles.
1. Bodey, G. P., Buckley, M., Sathe, Y. S. & Freireich, E. J. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann. Intern. Med. 64, 328–340 (1966).
2. Lehrnbecher, T. et al. Guideline for the Management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J. Clin. Oncol. 35, 2082–2094. https://doi.org/10.1200/JCO.2016.71.7017 (2017).
3. Deutsche Gesellschaft für Pädiatrische Infektologie (DGPI) und Gesellschaft Pädiatrische Onkologie und Hämatologie (GPOH) (2016) AWMF S2K Leitlinie: Diagnostik und Therapie bei Kindern mit onkologischer Grunderkrankung, Fieber und Granulozytopenie (mit febriler Neutropenie) außerhalb der allogenen Stammzelltransplantation. AWMF-Registernummer 048/14, finale Version 23.01.2016, accessed 25 July 2021 https://www.awmf.org/uploads/tx_szleitlinien/048-014l_S2k_onkologische_Grunderkrankung_Fieber_Granulozytopenie_201604verlaengert.pdf
4. Lehrnbecher, T. et al. 8th European conference on infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol. 22(6), e270–e280 (2021).
5. Lindblom, A. et al. Respiratory viruses, a common microbiological finding in neutropenic children with fever. J. Clin. Virol. 47(3), 234–237. https://doi.org/10.1016/j.jcv.2009.11.026 (2010).
Cited by
5 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献