Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia

Abstract

The time to antibiotic administration (TTA) has been proposed as a quality-of-care measure in febrile neutropenia (FN); however, few data regarding the impact of the TTA on the mortality of adult cancer patients with FN are available. The objective of this study was to determine whether the TTA is a predictor of mortality in adult cancer patients with FN. A prospective cohort study of all consecutive cases of FN, evaluated from October 2009 to August 2011, at a single tertiary referral hospital in southern Brazil was performed. The TTA was assessed as a predictive factor for mortality within 28 days of FN onset using the Cox proportional hazards model. Kaplan-Meier curves were used for an assessment of the mortality rates according to different TTAs; the log-rank test was used for between-group comparisons. In total, 307 cases of FN (169 subjects) were evaluated. During the study period, there were 29 deaths. In a Cox regression analysis, the TTA was independently associated with mortality within 28 days (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.10 to 1.26); each increase of 1 h in the TTA raised the risk of mortality within 28 days by 18%. Patients with FN episodes with a TTA of ≤ 30 min had lower 28-day mortality rates than those with a TTA of between 31 min and 60 min (3.0% versus 18.1%; log-rank P = 0.0002). Early antibiotic administration was associated with higher survival rates in the context of FN. Efforts should be made to ensure that FN patients receive effective antibiotic therapy as soon as possible. A target of 30 min to the TTA should be adopted for cancer patients with FN.

FIG 1

Distribution of time to antibiotic therapy in 307 cases of febrile neutropenia.

FIG 2

Comparison of survival curves of FN cases (all episodes of FN) with a time to antibiotic administration (TTA) of between 31 min and 60 min versus those with a TTA of ≤30 min. The Bonferroni-corrected α level is 0.025.

FIG 3

Comparison of survival curves of FN cases (first episode of documented bacteremia) with a time to antibiotic administration (TTA) of between 31 min and 60 min versus those with a TTA of ≤30 min. The Bonferroni-corrected α level is 0.025.