Delaying antibiotics for neutropenic fever may not affect survival of cancer patients

Pennsylvania, December 30: According to a study published in the American Journal of Medical Quality, postponing antibiotic treatment for longer than 60 minutes after the time of fever identification in cancer patients with neutropenic fever has no adverse effects on short-term survival.

Wolters Kluwer publishes the journal under the Lippincott imprint.

More than 80 per cent patients receiving chemotherapy for a blood malignancy experience called neutropenia are characterised by low amounts of white blood cells called neutrophils, which fights infection. It happens as a result of chemotherapy, which also kills neutrophils and tumour cells.

A fever in a patient with neutropenia is considered a medical emergency, according to Adam Binder, MD, of Thomas Jefferson University Hospital in Philadelphia, and colleagues. The fever signals a severe decrease in neutrophils and therefore a compromised ability of the immune system to ward off infections. Neutropenic fever is defined as a temperature of at least 101°, or a sustained temperature of at least 100.4° for an hour or more.

The Infectious Disease Society of America and the American Society of Clinical Oncology have both published guidelines for treating outpatients who have a neutropenic fever. Both organizations call for administering an intravenous antibiotic within 60 minutes after the fever is detected. The recommendation about antibiotics is also often applied to treating hospital inpatients, but there's no clear evidence that it's appropriate.

Comparing inpatients who did or did not receive antibiotics during the recommended treatment window

Dr Binder and his colleagues looked back at data on 187 patients at their hospital who had developed a neutropenic fever. Their main goal was to see whether delays in antibiotic treatment affected short-term survival.

Only 14 per cent of patients received antibiotics within 60 minutes of developing a neutropenic fever. Their survival rate 6 months later wasn't significantly better than the survival rate of patients who received antibiotics later than recommended.

Further analysis identified several factors that had a statistically significant association with the risk of death.

Patients with insurance had a 72 per cent lower risk of death than those without insurancePatients with at least one other major medical condition had a 2.7 times greater risk of death than those with blood cancer alone.

Patients who were treated with antibiotics within 40 minutes actually had a 5.7 greater risk of death than those who didn't receive antibiotics so quickly. A possible explanation for the last finding, the researchers say, is that patients who received antibiotics within 40 minutes "had other symptoms that yielded a concerning clinical picture, thus leading to a timelier administration of antibiotics, but ultimately a worse clinical outcome."

Guidelines for the treatment of outpatients may not apply to hospitalized patients even a delay of more than 4 hours wasn't long enough to affect survival, Dr Binder and his colleagues determined. That result is consistent with information from previous studies of inpatients, they said.

The authors believe existing treatment guidelines are appropriate for patients with neutropenic fever who are treated in a physician's office or an emergency department. Still, other factors must be considered for patients who have been admitted to a hospital. "Unlike neutropenic fever patients presenting to the emergency department, where true time to antibiotic administration may often be many hours or even days before arrival, a few hours long [delay] in the hospital may not be sufficiently long enough to cause significant patient harm", they said.

Delaying antibiotics for neutropenic fever may not affect survival of cancer patients
ANI 31 December 2022 Post Your Comments

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