A retrospective analysis of clinical acuity markers on hospital length of stay in patients with febrile neutropenia

Abstract

Objective

The primary objective of this study was to identify factors that have predictive value in determining total hospital length of stay in patients with febrile neutropenia, particularly time to first antibiotic dose.

Methods

This study was a retrospective chart review analyzing patients admitted to a 443 bed tertiary county teaching hospital from 1 November 2010 through 1 November 2015. Patients were eligible for enrollment into the study if they met Infectious Diseases Society of America accepted criteria for febrile neutropenia.

Results

Ninety-three patients were included for analysis. Time to first antibiotic dose, first empirically appropriate antibiotic dose, and time to first isolate-appropriate antibiotic did not show a significant correlation to total hospital length of stay (p = 0.71, p = 0.342, and p = 0.77, respectively). Subject’s Multinational Association for Supportive Care in Cancer and Simplified Acute Physiology II scores were significantly correlated with hospital lengths of stay (p = 0.0052, rs = −0.243 and p = 0.0001, rs = 0.344, respectively). Higher median (interquartile ranges) Simplified Acute Physiology II scores were also associated with hospital mortality [dead = 46 (34.8–51.7) vs. alive = 34 (28–43.3), p = 0.0173].

Conclusions

Measures of patient acuity, such as the Multinational Association for Supportive Care in Cancer and Simplified Acute Physiology II scores, did show a correlation to clinical outcomes in patients with febrile neutropenia. Timing of initial antibiotics between 2.32 and 6.27 hours after presentation in patients with febrile neutropenia did not correlate with clinical outcomes.

Keywords

Neutropenic fever antibiotic timing hospital length of stay hospital mortality

Get full access to this article

View all access options for this article.

References

Keng

Thallner

Elson

et al.

Reducing time to antibiotic administration for febrile neutropenia in the emergency department. J Oncol Pract 2015; 11: 450–455.

Crawford

Dale

Lyman

. Chemotherapy-induced neutropenia: Risks, consequences, and new directions for its management. Cancer 2004; 100: 228–237.

Greil

Psenak

Roila

et al.

Hematopoietic growth factors: ESMO recommendations for the applications. Ann Oncol 2008; 19: 116–118.

Klastersky

Ameye

Maertens

et al.

Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents 2007; 30: 51–59.

Sutter

Dradshaw

Simkins

et al.

High incidence of multidrug-resistant Gram-negative bacteria recovered from Afghan patients at a developed US military hospital. Infect Control Hosp Epidemiol 2011; 32: 854–860.

Cameron

. Management of chemotherapy-associated febrile neutropenia. Br J Cancer 2009; 101: 18–22.

Michels

Barron

Reynolds

et al.

Costs associated with febrile neutropenia in the US. Pharmacoeconomics 2012; 30: 809–823.

QxMD. MASCC Febrile Neutropenia Risk, www.qxmd.com/calculate/calculator_134/mascc-febrile-neutropenia-risk (accessed 27 July 2017).

Clin Calc. SAPS II Calculator, http://clincalc.com/icumortality/sapsii.aspx (accessed 27 July 2017).

10.

Freifeld

Bow

Sepkowitz

et al.

Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 2011; 52: 56–93.

11.

Baden LR, Swaminathan S, Angarone M, et al. NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections. Version 1.2017, NCCN.org (accessed 21 February 2017).

12.

Baden LR, Bensinger W, Angarone M, et al. NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections. Version 2.2014, NCCN.org (accessed 15 August 2015).

13.

Penack

Buccheidt

Christopeit

et al.

Management of sepsis in neutropenic patients: Guidelines from the infectious diseases working party of the German Society of Hematology and Oncology. Ann Oncol 2011; 22: 1019–1029.

14.

de Naurois

Novitzky-Basso

Gill

et al.

Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol 2010; 21: 252–256.

15.

Flowers

Seidenfeld

Bow

et al.

Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013; 31: 794–810.

16.

Tam

O’Reilly

Andresen

et al.

Use of empiric antimicrobial therapy in neutropenic fever. Intern Med J 2011; 41: 90–101.

17.

Kyriacou

Jovanovic

Frankfurt

. Timing of initial antibiotic treatment for febrile neutropenia in the emergency department: The need for evidence-based guidelines. J Natl Compr Canc Netw 2014; 12: 1569–1573.

18.

Ahn

Lee

et al.

Impact of time to antibiotics on outcomes of chemotherapy-induced febrile neutropenia. Support Care Cancer 2015; 23: 2799–2804.

19.

Butts AR, Bachmeier CC, Dressler EV, et al. Association of time to antibiotics and clinical outcomes in adult hematologic malignancy patients with febrile neutropenia. J Oncol Pharm Pract 2017; 23: 278–283. https://doi.org/10.1177/1078155216687150.

20.

Lynn

Chen

Weng

et al.

Risk factors associated with complications in patients with chemotherapy-induced febrile neutropenia in emergency department. Hematol Oncol 2013; 31: 189–196.

21.

Perron

Emara

Ahmed

. Times to antibiotics and outcomes in cancer patients with febrile neutropenia. BMC Health Serv Res 2014; 14: 162–162.

22.

Fletcher

Hodgkiss

Zhange

et al.

Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer. Pediatr Blood Cancer 2013; 8: 1299–1306.

23.

Blot

Cordonnier

Buzin

et al.

Severity of illness scores: Are they useful in febrile neutropenic patients in hematology wards? A prospective multicenter study. Crit Care Med 2001; 11: 2125–2131.

24.

Cho

Lee

Choi

et al.

Impact of vancomycin resistance on mortality in neutropenic patients with enterococcal bloodstream infection: A retrospective study. BMC Infect Dis 2013; 13: 504–504.