Butts Allison R, Bachmeier Christina Carracedo, Dressler Emily V, Liu Meng, Cowden Ann, Talbert Jeff, Adams Val R
1 Markey Cancer Center, University of Kentucky HealthCare, Lexington, KY, USA.
2 Department of Pharmacy, Lee Memorial Health System, Fort Myers, FL, USA.
J Oncol Pharm Pract. 2017 Jun;23(4):278-283. doi: 10.1177/1078155216687150. Epub 2017 Jan 11.
Objective The objective of this study was to determine the clinical impact of time to antibiotic administration in adult inpatients who have hematologic malignancies and develop febrile neutropenia. Methods A retrospective chart review was conducted to screen for all febrile neutropenia events amongst adult hematologic malignancy patients between 1 January 2010 and 1 September 2014. All included patients were admitted to the hospital at the time of fever onset, having been admitted for a diagnosis other than febrile neutropenia. Descriptive statistics and logistic generalized estimated equations were used to analyze the data. Results Two hundred forty-four neutropenic fever events met inclusion criteria. Thirty-five events (14.34%) led to negative clinical outcomes (in-hospital mortality, intensive care unit transfer, or vasopressor requirement), with an in-house mortality rate of 7.4%. The time to antibiotics ranged from 10 min to 1495 min. The median time to antibiotics in the events that led to negative outcomes was 120 min compared to 102 min in the events that did not lead to the negative outcome ( p = 0.93). Conditional order sets were used to order empiric antibiotics in 176 events (72.1%) and significantly reduced time to antibiotics from 287 min to 143 min ( p = 0.0019). Conclusion Prolonged time to antibiotic administration in hematologic malignancy patients who develop neutropenic fever was not shown to be associated with negative clinical outcomes.
目的 本研究的目的是确定抗生素给药时间对患有血液系统恶性肿瘤并发生发热性中性粒细胞减少症的成年住院患者的临床影响。方法 进行回顾性病历审查，以筛查2010年1月1日至2014年9月1日期间成年血液系统恶性肿瘤患者中的所有发热性中性粒细胞减少症事件。所有纳入患者在发热发作时入院，入院诊断不是发热性中性粒细胞减少症。使用描述性统计和逻辑广义估计方程分析数据。结果 244例中性粒细胞减少性发热事件符合纳入标准。35例事件（14.34%）导致不良临床结局（院内死亡、转入重症监护病房或需要血管升压药），院内死亡率为7.4%。抗生素给药时间为10分钟至1495分钟。导致不良结局的事件中抗生素给药的中位时间为120分钟，而未导致不良结局的事件中为102分钟（p = 0.93）。176例事件（72.1%）使用条件医嘱集开具经验性抗生素，显著缩短了抗生素给药时间，从287分钟降至143分钟（p = 0.0019）。结论 发生中性粒细胞减少性发热的血液系统恶性肿瘤患者抗生素给药时间延长未显示与不良临床结局相关。
