In cancer patients with neutropenic fever, delaying antibiotic treatment past 60 minutes from the time of fever detection doesn’t reduce the short-term probability of survival, in accordance with a study within the American Journal of Medical Quality. The journal is published within the Lippincott portfolio by Wolters Kluwer.

Neutropenia-;low levels of white blood cells called neutrophils, which fight infection-;develops in greater than 80% of patients who receive chemotherapy for a blood cancer. It occurs because chemotherapy destroys neutrophils together with tumor cells.

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

The Infectious Disease Society of America and the American Society of Clinical Oncology have each published guidelines for treating outpatients who’ve neutropenic fever. Each organizations call for administering an intravenous antibiotic inside 60 minutes after the fever is detected. The suggestion about antibiotics can be often applied to the treatment of hospital inpatients, but there is not any clear evidence that is appropriate.

Comparing inpatients who did or didn’t receive antibiotics throughout the really useful treatment window

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

Only 14% of patients received antibiotics inside 60 minutes of developing neutropenic fever. Their survival rate 6 months later wasn’t significantly higher than the survival rate of patients who received antibiotics later than really useful.

Further evaluation identified several aspects that had a statistically significant association with the chance of death:

• Patients with insurance had a 72% lower risk of death than those without insurance
• Patients with a minimum of 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 inside 40 minutes actually had a 5.7 greater risk of death than those that didn’t receive antibiotics so quickly

A possible explanation for the last finding, the researchers say, is that patients who received antibiotics inside 40 minutes “had other symptoms that yielded a concerning clinical picture, thus resulting in a timelier administration of antibiotics, but ultimately a worse clinical final result.”

Guidelines for treatment of outpatients may not apply to hospitalized patients

Even a delay of greater than 4 hours wasn’t long enough to affect survival, Dr. Binder and his colleagues determined. That result’s consistent with information from previous studies of inpatients, they are saying.

The authors imagine existing treatment guidelines are appropriate for patients with neutropenic fever who’re treated in a physician’s office or an emergency department, but other aspects have to be considered for patients who’ve 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 and even days before arrival, just a few hours long [delay] within the hospital will not be sufficiently long enough to cause significant patient harm.”

Source:

Journal reference:

Villars, J., et al. (2022) Delay in Time to Antibiotics for De Novo Inpatient Neutropenic Fever May Not Impact Overall Survival for Patients With a Cancer Diagnosis. American Journal of Medical Quality. doi.org/10.1097/JMQ.0000000000000093.