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Published on: August 30, 2018
Impact of Time-to-Antibiotic Delivery in Pediatric Patients With Cancer Presenting With Febrile Neutropenia
George C De Castro1, Leonora R Slatnick2, Morgan Shannon1
1Vanderbilt University School of Medicine, Nashville, TN.
Insights
Prompt antibiotics for febrile neutropenia (FN) in pediatric cancer patients are crucial. However, this study found no clear evidence that a time-to-antibiotic metric under 60 minutes improves clinical outcomes.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Quality Improvement Science
Background:
- Febrile neutropenia (FN) in pediatric cancer patients can lead to severe infections, necessitating prompt antibiotic administration.
- A time-to-antibiotic (TTA) metric of less than 60 minutes is often used, influenced by data from other populations and impacting national quality rankings.
Purpose of the Study:
- To evaluate the association between time-to-antibiotic administration and clinical outcomes in pediatric oncology patients with febrile neutropenia.
- To determine if a TTA of less than 60 minutes is a reliable quality measure for pediatric oncology programs.
Main Methods:
- Retrospective analysis of febrile neutropenia episodes at two children's hospitals (Vanderbilt Children's Hospital and Colorado Children's Hospital).
- Data abstracted included TTA, intensive care unit (ICU) admission, vasopressor use, intubation, and infection-related mortality.
- Statistical analysis using adjusted odds ratios to control for potential confounders.
Main Results:
- A total of 2,349 episodes were analyzed.
- The median TTA was 56 minutes, with 54.3% of patients receiving antibiotics within 60 minutes.
- No significant association was found between TTA (<60 or ≥60 minutes) and major complications or any complications when analyzed as a continuous variable.
Conclusions:
- Current evidence does not support a reduced time-to-antibiotic metric as a primary quality measure for pediatric oncology febrile neutropenia.
- The established <60-minute TTA benchmark may not be clinically justified for improving outcomes in this patient population.
Purpose:
Febrile neutropenia (FN) in pediatric patients with cancer can cause severe infections, and prompt antibiotics are warranted. Extrapolated from other populations, a time-to-antibiotic (TTA) metric of <60 minutes after medical center presentation was established, with compliance data factoring into pediatric oncology program national rankings.
Methods:
All FN episodes occurring at Vanderbilt Children's Hospital (2007-February 2022) and a sample of episodes from Colorado Children's Hospital (2012-2019) were abstracted, capturing TTA and clinical outcomes including major complications (intensive care unit [ICU] admission, vasopressors, intubation, or infection-related mortality). Odds ratios (ORs) were adjusted for age, treatment center, absolute neutrophil count, hypotension presence, stem-cell transplant status, and central line type.
Results:
A total of 2,349 episodes were identified from Vanderbilt (1,920) and Colorado (429). Only 0.6% (n = 14) episodes required immediate ICU management, with a median TTA of 28 minutes (IQR, 20-37). For the remaining patients, the median TTA was 56 minutes (IQR, 37-90), and 54.3% received antibiotics in <60 minutes. There were no significant associations between TTA (<60 or ≥60 minutes) and major complications (adjusted OR, 0.99 [95% CI, 0.62 to 1.59]; P = .98), and a TTA ≥60 minutes was not associated with any type of complication. Similarly, TTA, when evaluated as a continuous variable, was not associated with a major (OR, 0.99 [95% CI, 0.94 to 1.04]; P = .69) nor any other complication in adjusted analysis.
Conclusion:
There is no clear evidence that a reduced TTA improves clinical outcomes in pediatric oncology FN and thus it should not be used as a primary quality measure.
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