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. 2020 May;28(5):2369-2380.
doi: 10.1007/s00520-019-05056-w. Epub 2019 Sep 5.

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Christa Koenig  1   2 , Christine Schneider  3 , Jessica E Morgan  4   5 , Roland A Ammann  3 , Lillian Sung  6 , Bob Phillips  4   5
Affiliations

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Christa Koenig et al. Support Care Cancer. 2020 May.

Abstract

Purpose: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

Keywords: Cancer; Fever; Neutropenia; Oncology; Quality improvement projects; Systematic review; Time to antibiotics.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of identification and selection of eligible studies
Fig. 2
Fig. 2
Relative reduction in TTA of studies reporting mean and standard deviation or when those parameters could be estimated
See this image and copyright information in PMC

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