Time-to-antibiotic administration as a quality of care measure in children with febrile neutropenia: A survey of pediatric oncology centers

University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatric Blood & Cancer (Impact Factor: 2.39). 02/2012; 58(2):303-5. DOI: 10.1002/pbc.23148
Source: PubMed


Time-to-antibiotic administration (TTA) has been suggested as a quality-of-care (QOC) measure for pediatric oncology patients with febrile neutropenia (FN). Unknown, however, is to what extent pediatric oncology centers utilize TTA. Therefore, we designed and administered an electronic survey (68% response rate) of programs in the Children's Oncology Group to assess TTA utilization. Nearly half of respondents track TTA. Most reported using a benchmark of less than 60 min from arrival. TTA is a commonly used QOC measure for pediatric FN despite an absence of studies establishing its validity and a lack of data supporting its impact on outcomes of FN.

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Available from: Naomi Winick, Mar 19, 2015
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    ABSTRACT: Background: Time-to-antibiotic (TTA) administration is a widely used quality-of-care measure for children with cancer and febrile neutropenia (FN). We sought to determine whether TTA is associated with outcomes of FN. Procedure: A single-center, retrospective cohort study was conducted of 1,628 FN admissions from 653 patients from 2001 to 2009. Outcome variables included (1) an adverse event (AE) composite of in-hospital mortality, pediatric intensive care unit (PICU) admission within 24 hours of presentation, and/or fluid resuscitation ≥ 40 ml/kg within 24 hours of presentation and (2) length of stay (LOS). TTA was measured as a continuous variable and in 60-minute intervals. Mixed regression models were constructed to evaluate associations of TTA with the outcome variables after adjusting for relevant covariates including cancer diagnosis, degree of myelosuppression, and presence of bacteremia. Results: The composite AE outcome occurred in 11.1% of admissions including 0.7% in-hospital mortality, 4.7% PICU admission, and 10.1% fluid resuscitation. In univariate analysis, TTA was associated with the composite AE outcome (Odds Ratio [OR] 1.29, 95% CI 1.02-1.64) but not LOS. In multivariate analysis, after adjustment for relevant covariates, 60-minute TTA intervals were associated with the composite AE outcome (61-120 minutes vs. ≤ 60 minutes, OR 1.81, 95% CI 1.01-3.26). Unexpectedly, admission from the emergency department (ED) was also independently associated with the composite AE outcome (ED vs. clinic, OR 3.15, 95% CI 1.95-5.09). Conclusions: TTA and presentation to the ED are independently associated with poor outcomes of FN.
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    ABSTRACT: Background: 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 TTA on mortality of adult cancer patients with FN are available.Objective: To determine whether TTA is a predictor of mortality in adult cancer patients with FN.Methods: 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. TTA was assessed as a predictive factor for 28-day mortality using the Cox proportional hazards model. Kaplan-Meier curves were used for assessment of mortality rates according to different TTAs; the log-rank test was used for between-group comparisons.Results: In total, 307 cases of FN (169 subjects) were evaluated. During the study period, there were 29 deaths. In a Cox regression analysis, TTA was independently associated with 28-day mortality (HR 1.18 [95% CI 1.10 to 1.26]); each increase of 1 h in the TTA raised the risk of 28-day mortality by 18%. FN episodes with TTA ≤30 min had lower 28-day mortality rates compared with those with TTA between 31 min and 60 min (3.0% versus 16.6%; log-rank P=0.0002).Conclusions: 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 TTA should be adopted for cancer patients with FN.
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