Variation in Antibiotic Prescription in High-Risk Febrile Neutropenia in Portuguese Hospitals

Area of Science:

• Hematology
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Febrile neutropenia (FN) poses a severe risk to hemato-oncologic patients, often complicated by multidrug-resistant bacteria.
• Inconsistent clinical guidelines lead to varied antimicrobial prescribing practices for FN.
• Portuguese hematologists' approaches to high-risk FN antimicrobial therapy require evaluation.

Purpose of the Study:

• To assess variations in antimicrobial therapy practices for high-risk febrile neutropenia among Portuguese hematologists.
• To identify factors influencing the adoption of narrow-spectrum, short-course, and de-escalation strategies.

Main Methods:

• A cross-sectional online survey was distributed to clinical hematologists nationwide.
• Three clinical vignettes addressed empiric narrow-spectrum antibiotics, short-course therapy, and de-escalation in FN management.
• Survey questions also covered clinical experience, hospital size, and decision-making processes for FN antibiotic therapy.

Main Results:

• Thirty-one hematologists from 11 hospitals participated.
• All respondents utilized empiric narrow-spectrum antibiotics for high-risk FN.
• Short-course therapy was adopted by 22.6% (more common among senior specialists in larger centers), and de-escalation by 35.5% (more common among younger specialists).
• Availability of an FN protocol correlated with increased use of both short-course and de-escalation strategies.

Conclusions:

• While empiric narrow-spectrum antibiotic use is consistent, significant variation exists in the application of short-course therapy and de-escalation for high-risk FN in Portugal.
• Specialist experience and institutional protocols appear to influence these therapeutic decisions.
• Further qualitative research is needed to understand barriers to optimal antibiotic use and inform targeted interventions for improving febrile neutropenia management.