Uda Hiroki, Suga Yukio, Toriba Eriko, Staub Angelina Yukiko, Shimada Tsutomu, Sai Yoshimichi, Kawahara Masami, Matsusita Ryo
1Department of Clinical Drug Informatics, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan.
Department of Pharmacy, Kanazawa Municipal Hospital, 3-7-3 Heiwamachi, Kanazawa, Ishikawa 921-8105 Japan.
J Pharm Health Care Sci. 2019 Feb 4;5:3. doi: 10.1186/s40780-018-0130-2. eCollection 2019.
Medical staff should promptly administer antimicrobials to patients with febrile neutropenia (FN) to decrease the mortality related to cancer chemotherapy. Corticosteroids, which are used in cancer chemotherapy, have a fever-suppressive effect. This effect could lead to a blunt fever response and any local signs of infection, especially in patients receiving multiday corticosteroid administration. The aim of this study was to determine whether multiday corticosteroid administration in cancer chemotherapy delays the diagnosis of and antimicrobial treatment for FN.
We conducted a double-center retrospective study in Japanese patients with FN. The patients were divided into two groups based on the corticosteroid administration method, i.e., whether administration was multiday or not. To evaluate the degree of masking on FN by corticosteroids, we assessed the correlation between body temperature variation and time of antimicrobial administration after the initiation of chemotherapy. Risk factors for delayed antimicrobial administration were identified by multiple logistic regression analysis.
Two hundred thirteen patients were analyzed. The median time required to body temperature reaching 37.5 °C and for antimicrobial administration was longer in the multiday group than in the non-multiday group, with 0.64 and 0.60 days ( = 0.002 and < 0.001), respectively. Multiday corticosteroid use was identified as an independent risk factor for delayed antimicrobial administration (odds ratio = 3.94; 95% confidence interval = 1.80-8.62; < 0.001).
Multiday corticosteroid administration in cancer chemotherapy delayed the diagnosis of and antimicrobial administration for FN. Furthermore, it was the only risk factor for delayed antimicrobial administration. We could thus provide evidence that the diagnosis of and antimicrobial administration for FN in patients receiving multiday corticosteroid administration should not be based on body temperature variation alone.
医护人员应及时为发热性中性粒细胞减少症（FN）患者使用抗菌药物，以降低与癌症化疗相关的死亡率。用于癌症化疗的皮质类固醇具有退热作用。这种作用可能导致发热反应迟钝以及任何局部感染迹象，尤其是在接受多日皮质类固醇治疗的患者中。本研究的目的是确定癌症化疗中多日使用皮质类固醇是否会延迟FN的诊断和抗菌治疗。
我们对日本FN患者进行了一项双中心回顾性研究。根据皮质类固醇给药方法将患者分为两组，即给药是否为多日。为了评估皮质类固醇对FN的掩盖程度，我们评估了化疗开始后体温变化与抗菌药物给药时间之间的相关性。通过多因素逻辑回归分析确定延迟使用抗菌药物的危险因素。
共分析了213例患者。多日组体温达到37.5°C所需的中位时间和抗菌药物给药时间均长于非多日组，分别为0.64天和0.60天（P = 0.002和P < 0.001）。多日使用皮质类固醇被确定为延迟使用抗菌药物的独立危险因素（比值比 = 3.94；95%置信区间 = 1.80 - 8.62；P < 0.001）。
癌症化疗中多日使用皮质类固醇延迟了FN的诊断和抗菌药物给药。此外，它是延迟使用抗菌药物的唯一危险因素。因此，我们可以提供证据表明，对于接受多日皮质类固醇治疗的患者，FN的诊断和抗菌药物给药不应仅基于体温变化。
