Naeem Doaa, Alshamrani Majed A, Aseeri Mohammed A, Khan Mansoor A
Pharmaceutical Care Department, Ministry of National Guard Health Affairs, King Saud bin Abdul Aziz University for Health Sciences, King Abdul Aziz Medical City, Jeddah 11481, Saudi Arabia.
Pharmacy (Basel). 2018 Aug 10;6(3):83. doi: 10.3390/pharmacy6030083.
Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines and to describe the pattern of bacterial infections. We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline non-compliant treatment. The most common non-compliant treatment was incorrect amikacin dosing in 31% of patients, followed by incorrect vancomycin dosing in 20%, incorrect piperacillin/tazobactam dosing in 19%, inappropriate use of carbapenems in 18%, and non-compliant vancomycin use in 12% of patients. Bacterial isolates were only observed in 19% of the FN episodes. Among these 19 episodes of FN, Gram-negative pathogens were predominant and were identified in 74% of the episodes, followed by Gram-positive pathogens in 16% and polymicrobial pathogens in 10%. The mean time to defervescence was 2.21 ± 2 days. Our study concluded that there was a high percentage of non-compliance with our institutional FN management guidelines. We recommend following appropriate empiric antibiotic doses and indications as per institutional guidelines.
发热性中性粒细胞减少症（FN）是一种肿瘤急症，应立即使用经验性抗生素进行治疗。不同机构观察到不同的抗菌谱，并使用不同的FN管理指南。我们中心于2009年实施了针对成年癌症患者的FN管理指南。因此，我们决定评估对FN管理指南的依从性，并描述细菌感染的模式。我们对所有因FN入院的成年癌症患者进行了一项横断面研究。数据收集自2014年1月至12月的电子病历。100例FN发作符合研究纳入标准。患者的平均年龄为41±17岁；52%（52例）为女性。最常见的诊断是淋巴瘤（33%）。在对机构FN指南的依从性方面，55%的患者接受了不符合指南的治疗。最常见的不符合指南的治疗是31%的患者阿米卡星剂量不正确，其次是20%的患者万古霉素剂量不正确，19%的患者哌拉西林/他唑巴坦剂量不正确，18%的患者碳青霉烯类药物使用不当，12%的患者万古霉素使用不符合规定。仅在19%的FN发作中观察到细菌分离株。在这19例FN发作中，革兰氏阴性病原体占主导地位，在74%的发作中被鉴定出来，其次是革兰氏阳性病原体占16%，多微生物病原体占10%。退热的平均时间为2.21±2天。我们的研究得出结论，对我们机构的FN管理指南不依从的比例很高。我们建议按照机构指南遵循适当的经验性抗生素剂量和适应症。
