Impact of time to antibiotic administration on mortality in patients with febrile neutropenia: a cohort study.
Antimicrob Agents Chemother. 2014 Apr 21;
Authors: Rosa RG, Goldani LZ
Background: Time to antibiotic administration (TTA) has been proposed as a quality-of-care measure in febrile neutropenia (FN); however, few data regarding the impact of TTA on mortality of adult cancer patients with FN are available.Objective: To determine whether TTA is a predictor of mortality in adult cancer patients with FN.Methods: A prospective cohort study of all consecutive cases of FN, evaluated from October 2009 to August 2011, at a single tertiary referral hospital in Southern Brazil was performed. TTA was assessed as a predictive factor for 28-day mortality using the Cox proportional hazards model. Kaplan-Meier curves were used for assessment of mortality rates according to different TTAs; the log-rank test was used for between-group comparisons.Results: In total, 307 cases of FN (169 subjects) were evaluated. During the study period, there were 29 deaths. In a Cox regression analysis, TTA was independently associated with 28-day mortality (HR 1.18 [95% CI 1.10 to 1.26]); each increase of 1 h in the TTA raised the risk of 28-day mortality by 18%. FN episodes with TTA ≤30 min had lower 28-day mortality rates compared with those with TTA between 31 min and 60 min (3.0% versus 16.6%; log-rank P=0.0002).Conclusions: Early antibiotic administration was associated with higher survival rates in the context of FN. Efforts should be made to ensure that FN patients receive effective antibiotic therapy as soon as possible. A target of 30 min to TTA should be adopted for cancer patients with FN.
PMID: 24752269 [PubMed - as supplied by publisher]