Factors and Outcomes Related to the Use of Guideline-Recommended Antibiotics in Patients With Neutropenic Fever at the Uganda Cancer Institute.
Factors and Outcomes Related to the Use of Guideline-Recommended Antibiotics in Patients With Neutropenic Fever at the Uganda Cancer Institute.
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DOI：
10.1093/ofid/ofab307
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发表时间：
2021-07
影响因子：
4.2
通讯作者：
Moore CC
中科院分区：
文献类型：
--
作者：
Gulleen EA;Adams SV;Chang BH;Falk L;Hazard R;Kabukye J;Scala J;Liu C;Phipps W;Abrahams O;Moore CC
中性粒细胞减少性发热 (NF) 与撒哈拉以南非洲 (sSA) 接受癌症治疗的患者的显着发病率和死亡率相关。然而，撒哈拉以南非洲地区 NF 的抗生素管理尚未得到很好的描述。我们在乌干达癌症研究所 (UCI) 评估了 NF 患者抗生素使用的时机和选择。我们对 2016 年 1 月 1 日至 2017 年 5 月 31 日入住 UCI 的患有 NF 的成人急性白血病进行了回顾性图表审查。对于每个 NF 事件，我们评估了临床表现和人口统计学与抗生素选择的关联，以及初始抗生素和指南推荐抗生素的使用时间。我们还评估了订购的抗生素与院内病死率（CFR）之间的关联。 39 名患者中发生了 49 起 NF 事件。最初订购抗生素的时间<1天。针对 37 例 (75%) NF 事件，使用了指南推荐的抗生素。指南推荐的抗生素使用时间中位为 3 天。入院时发烧、体检记录和腹部异常与初始抗生素和指南推荐抗生素的使用时间较短有关。院内病死率为 43%。服用指南推荐的抗生素与未服用指南推荐的抗生素或未服用抗生素时的院内死亡率没有差异（风险比分别为 0.51 [95% 置信区间 {CI}, 0.10–2.64] 和 0.78 [95% CI, 0.20–2.96]）。患有急性白血病和 NF 的患者延迟了指南推荐的抗生素的使用，并且 CFR 较高。需要进行前瞻性研究来确定撒哈拉以南非洲地区的最佳 NF 管理，包括抗生素的选择和抗生素开始使用的时间。我们检查了乌干达癌症研究所 49 例急性白血病成人患者对指南推荐抗生素的依从性。 37 起 (75%) 事件中订购了指南推荐的抗生素，但订购指南推荐的抗生素的中位时间为 3 天。
Neutropenic fever (NF) is associated with significant morbidity and mortality for patients receiving cancer treatment in sub-Saharan Africa (sSA). However, the antibiotic management of NF in sub-Saharan Africa has not been well described. We evaluated the timing and selection of antibiotics for patients with NF at the Uganda Cancer Institute (UCI). We conducted a retrospective chart review of adults with acute leukemia admitted to UCI from 1 January 2016 to 31 May 2017, who developed NF. For each NF event, we evaluated the association of clinical presentation and demographics with antibiotic selection as well as time to both initial and guideline-recommended antibiotics. We also evaluated the association between ordered antibiotics and the in-hospital case fatality ratio (CFR). Forty-nine NF events occurred among 39 patients. The time to initial antibiotic order was <1 day. Guideline-recommended antibiotics were ordered for 37 (75%) NF events. The median time to guideline-recommended antibiotics was 3 days. Fever at admission, a documented physical examination, and abdominal abnormalities were associated with a shorter time to initial and guideline-recommended antibiotics. The in-hospital CFR was 43%. There was no difference in in-hospital mortality when guideline-recommended antibiotics were ordered as compared to when non-guideline or no antibiotics were ordered (hazard ratio, 0.51 [95% confidence interval {CI}, .10–2.64] and 0.78 [95% CI, .20–2.96], respectively). Patients with acute leukemia and NF had delayed initiation of guideline-recommended antibiotics and a high CFR. Prospective studies are needed to determine optimal NF management in sub-Saharan Africa, including choice of antibiotics and timing of antibiotic initiation. We examined adherence to guideline-recommended antibiotics in 49 neutropenic fever episodes among adults with acute leukemia at the Uganda Cancer Institute. Guideline-recommended antibiotics were ordered in 37 (75%) events, but median time to guideline-recommended antibiotic order was 3 days.