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Retrospective Study Of The Management Of Suspected Febrile Neutropenia In A Single-Centre Metropolitan Western Sydney Hospital

Authors Doyle SJ, Mackson JH, Salter MD

Received 5 June 2019

Accepted for publication 18 October 2019

Published 7 November 2019 Volume 2019:11 Pages 37—43

DOI https://doi.org/10.2147/CA.S218391

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Zoka Milan


Samuel J Doyle,1 Joanne H Mackson,1 Mark D Salter1,2

1Emergency Department, Nepean Hospital NSW, Kingswood, NSW, Australia; 2School of Medicine, University of Sydney, Sydney, NSW, Australia

Correspondence: Mark D Salter
Emergency Department, Nepean Hospital NSW, Kingswood, NSW, Australia
Email mark.salter@health.nsw.gov.au

Objective: Febrile neutropenia is an oncological emergency, associated with considerable morbidity and mortality. The mainstay of initial treatment is broad-spectrum intravenous antibiotics. We aim to determine our level of performance primarily by determining the time to initial antibiotic administration amongst other secondary outcomes. We propose that this may assist in providing an improvement in service provision and the clinical outcomes of patients from updated and more site-centred recommendations.
Methods: A retrospective cohort study was conducted at the Nepean Hospital Emergency Department by two independent researchers from the hospital electronic and paper medical records. The primary outcome for the study was the time to initial antibiotics. Secondary outcomes included time to initial litre of intravenous fluids, time to antipyretics, number of positive culture or imaging results and the first-line antibiotic choice.
Results: A total of 244 patients were included. 127 patients (52.05%) received either Piperacillin-Tazobactam or cefepime, with or without gentamicin, which is congruent with the local clinical pathway. Mean time to administration of antibiotics for the cohort was 127 mins (82; 49.5–149 mins). Initial Intravenous fluid boluses were given to 177 patients (72.54%), with a mean time 166 mins (117; 64–196 mins) whilst 161 patients (65.98%) received antipyretics within 160 mins (90; 53–208 mins).
Conclusion: The results show a delay in treatment and variation in the selection of initial antibiotics at our centre. The results should lead to changes in staff education on the existence of guidelines, their recommendations and how the processes for the initiation of therapy can be improved at our centre. This may encourage other services to ascertain their performance and encourage them to identify obstacles to efficient and effective care to improve patient outcomes.

Keywords: febrile neutropenia, antibiotics, sepsis

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