Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department
| Autor: | Imola Barla, Elie Azoulay, Camille Gerlier, Léa Legay, Jean-Paul Fontaine, Sami Ellouze, Sylvie Chevret, Olivier Peyrony |
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| Přispěvatelé: | Emergency Department [Paris], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier Saint-Joseph [Paris], Intensive Care Unit [Paris], Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Paris (UP), Biostatistics and Medical Information Department [Paris], Bodescot, Myriam, Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université Paris Cité (UPCité) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Critical Care and Emergency Medicine Antibiotics Fevers Logistic regression Pathology and Laboratory Medicine White Blood Cells 0302 clinical medicine Animal Cells Neoplasms Medicine and Health Sciences 030212 general & internal medicine Multidisciplinary Antimicrobials Drugs Middle Aged Hospitals 3. Good health Anti-Bacterial Agents Intensive Care Units Treatment Outcome Oncology 030220 oncology & carcinogenesis Medicine Female Cellular Types Emergency Service Hospital Research Article Adult medicine.medical_specialty Neutropenia [SDV.SP.MED] Life Sciences [q-bio]/Pharmaceutical sciences/Medication medicine.drug_class Immune Cells Science Immunology [SDV.CAN]Life Sciences [q-bio]/Cancer Microbiology Sepsis 03 medical and health sciences Signs and Symptoms [SDV.CAN] Life Sciences [q-bio]/Cancer [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication Diagnostic Medicine Internal medicine Microbial Control medicine Humans Aged Febrile Neutropenia Pharmacology Blood Cells Performance status business.industry Biology and Life Sciences Emergency department Cell Biology medicine.disease Health Care Health Care Facilities [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie Complication business Febrile neutropenia |
| Zdroj: | PLoS ONE PLoS ONE, Public Library of Science, 2020, 15 (2), pp.e0229828. ⟨10.1371/journal.pone.0229828⟩ PLoS ONE, Vol 15, Iss 2, p e0229828 (2020) |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0229828⟩ |
| Popis: | International audience; INTRODUCTION:The benefit of reducing the time of antibiotic initiation in the emergency department (ED) for neutropenic patients is controversial and the research on the impact of antibiotic adherence to international guidelines in the ED is scarce. We aimed to investigate the effect of antibiotic timing and appropriateness on outcomes in patients with febrile neutropenia (FN) and to assess the performance of the MASCC risk-index to risk-stratify such patients in the ED.METHODS:We prospectively identified patients with FN who presented to our ED and assessed their Multinational Association of Supportive Care in Cancer (MASCC) risk-index. The time to parenteral antibiotic initiation and the appropriateness of the antibiotic regimen according to international guidelines were retrospectively abstracted. The performance of the MASCC risk-index in predicting the absence of complication was assessed with sensitivity, specificity and the area under the receiver operating characteristics curve (AUC). We investigated the effect of the time to antibiotic initiation and the appropriateness of the antibiotic regimen on the outcome (ICU admission or death) by logistic regression analyses.RESULTS:We included 249 patients. Median age was 60 years and 67.9% had hematological malignancies, 26 (10.4%) were admitted to the ICU and 23 (9.8%) died during hospital stay. Among the 173 patients at low risk according to the MASCC risk-index, 56 (32.4%) presented at least one complication including 11 deaths. The MASCC risk-index had a sensitivity and a specificity of 0.78% and 0.43%, respectively, in predicting the absence of complication and the AUC was 0.67. The time to antibiotic initiation in the ED was not associated with the outcome after adjusting for performance status and shock-index. Conversely, an inadequate ED antibiotic regimen was associated with higher ICU admission or death during hospital stay (OR = 3.50; 95% CI = 1.49 to 8.28).CONCLUSION:An inadequate ED antibiotic regimen in patients with FN was significantly associated with higher ICU admission or death during hospital stay. |
| Databáze: | OpenAIRE |
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