Evaluation of the Management of Febrile Neutropenia in a Tertiary Care Center

Introduction: Febrile neutropenia (FN) is defined by an absolute neutrophil count (ANC) less than or equal to 500 cells per microliter with a concurrent single oral body temperature of more than or equal to 38.3° C (orally) or more than 38.0° C maintained over one hour. There are different published guidelines for the management of FN. The primary objective of this study is to assess the management of FN in terms of choice, dose, and duration of empirical antimicrobial therapy and postculture results in our tertiary medical center. Methods: This is a retrospective review of medical records for patients admitted to the institution with a diagnosis of FN between 2018 and 2023. An electronic review of the medical records of all adult patients admitted with the diagnosis of FN was conducted through the platform of the medical records. A set of criteria for the evaluation of therapy was developed based on standard local and international guidelines. Results: The study included 280 patients who fit the inclusion/exclusion criteria. Around half of the patients did not have a focus of infection (48.9%). The overall treatment regimen was appropriate in only 32.1% of the patient cases which includes an appropriate choice, dose, and duration of therapy. The choice of the antimicrobial(s) was inappropriate in 49.3% of the patient cases. The dosing regimen and treatment duration were inappropriate in 36.5% and 19.3% of the patient cases, respectively. Conclusion: This study evaluated the appropriate management of FN at our medical center including the appropriate choice, dose, and duration of the antimicrobials used. The overall management of FN was inappropriate in two thirds of the patient cases (67.9%) when evaluated according to the assessment criteria. The choice, dose, and duration of treatment needs improvement for optimization of therapy and improvement of patient outcomes.