Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland.
Centre for Reviews and Dissemination, University of York, York, UK.
Support Care Cancer. 2020 May;28(5):2369-2380. doi: 10.1007/s00520-019-05056-w. Epub 2019 Sep 5.
Multiple interventions have been developed aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia (FN) following chemotherapy for cancer. We evaluated their effect to reduce TTA and their impact on important clinical outcomes in a systematic review.
The search covered seven databases. Biases and quality of studies were assessed with the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Interventions could be implemented in any setting and performed by any person included in the FN management. Absolute change of TTA was the primary outcome. Registration: PROSPERO (CRD42018092948).
Six thousand two hundred ninety-six titles and abstracts were screened, 177 studies were retrieved and 30 studies were included. Risk of bias was moderate to serious in 28 studies and low in two studies. All but one study reported a reduction of TTA after the intervention. Various types of interventions were implemented; they most commonly aimed at professionals. Most of the studies made more than one single intervention.
This review may help centers to identify their specific sources of delay and barriers to change and to define what intervention may be the best to apply. This review supports the assertion that TTA can be considered a measure of quality of care, emphasizes the importance of education and training, and describes the very different interventions which have effectively reduced TTA.
为了降低癌症化疗后发热伴中性粒细胞减少症（FN）患者的抗生素治疗时间（TTA），已经开发了多种干预措施。我们通过系统评价评估了这些措施在降低 TTA 方面的效果及其对重要临床结局的影响。
检索了七个数据库。使用非随机干预研究的偏倚风险（ROBINS-I）工具评估了研究的偏倚和质量。干预措施可以在任何环境中实施，并由参与 FN 管理的任何人执行。TTA 的绝对变化是主要结局。注册：PROSPERO（CRD42018092948）。
筛选了 6296 篇标题和摘要，检索到 177 篇研究，纳入了 30 篇研究。28 项研究的偏倚风险为中度至严重，2 项研究的偏倚风险为低。干预后，除了一项研究外，所有研究均报告了 TTA 的降低。实施了各种类型的干预措施；它们最常针对专业人员。大多数研究进行了不止一项单一的干预措施。
本综述可能有助于中心确定其特定的延迟来源和变革障碍，并确定可能应用的最佳干预措施。本综述支持 TTA 可被视为护理质量的衡量标准的观点，强调了教育和培训的重要性，并描述了可有效降低 TTA 的各种干预措施。
