A Quality Improvement Initiative to Optimize Fever and Neutropenia Management in Oncology Patients

Antibiotic durations in pediatric oncology inpatients with fever and neutropenia are often long, increasing the risk of adverse effects and selecting for antibiotic-resistant organisms. This quality improvement initiative aimed to decrease the monthly average empiric antibiotic duration for this population to 7 days or fewer.

Historically, a major driver of prolonged empiric antibiotic durations was treatment until bone marrow recovery. However, literature suggests that antibiotics may safely be stopped sooner in the absence of a documented infection. We created a clinical pathway that recommended a defined empiric antibiotic duration of 7 days in clinically stable patients. Using the Model for Improvement, the pathway was implemented and revised based on feedback from clinicians. To assess the initiative's impact, we measured the monthly average inpatient empiric antibiotic duration for oncology patients with fever and neutropenia. As a balancing measure, we tracked the monthly percentage of patients who had a positive blood culture within 72 hours of discontinuing antibiotics. We used statistical process control charts to evaluate changes over time.

The mean monthly average duration of inpatient empiric antibiotics for our target population decreased to 5.0 days. The percentage of patients who had a positive blood culture within 72 hours of discontinuing antibiotics remained stably low.

By implementing a clinical pathway that recommended a defined empiric antibiotic duration in stable patients, we successfully decreased antibiotic exposure for oncology patients with fever and neutropenia. We did not observe increased bacteremia events during the project period.