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

被引:24
作者
Daniels, Lisa M. [1 ]
Durani, Urshila [2 ]
Barreto, Jason N. [3 ]
O'Horo, John C. [4 ]
Siddiqui, Mustaqeem A. [5 ]
Park, John G. [6 ]
Tosh, Pritish K. [4 ]
机构
[1] Emory Univ, Sch Med, Dept Med, Div Pulm Allergy Crit Care & Sleep Med, 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342 USA
[2] Mayo Clin, Dept Med, Div Hematol, Div Med Oncol, Rochester, MN USA
[3] Mayo Clin, Dept Pharm, Rochester, MN USA
[4] Mayo Clin, Dept Med, Div Infect Dis, Rochester, MN USA
[5] Mayo Clin, Dept Med, Div Hematol, Rochester, MN USA
[6] Mayo Clin, Dept Med, Div Pulm & Crit Care Med, Rochester, MN USA
关键词
Fever neutropenia; Time to antibiotic; Hospital utilization; Sepsis and septic shock; Mortality; SEVERE SEPSIS; ANTIMICROBIAL AGENTS; SEPTIC SHOCK; CANCER; MANAGEMENT; OUTCOMES; GUIDELINES; INFECTION; MORBIDITY; SURVIVAL;
D O I
10.1007/s00520-019-04701-8
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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.
引用
收藏
页码:4171 / 4177
页数:7
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