Authors (including presenting author) :
Timothy Rainer(1)(2), Shi Yeow LEE(1), Pui Kin Rex LAM(1)(2), Dr Siu Chung LEUNG(1), Cynthia Yan Yiu Yu(1), Dr Tat Chi TSANG(2), Dr Rock Yuk Yan LEUNG(2)
Affiliation :
(1)The University of Hong Kong, Hong Kong SAR, China; (2)Queen Mary Hospital, Hospital Authority, Hong Kong SAR, China
Introduction :
Cancer patients attending emergency departments (ED) with fever and recent chemotherapy are often classified as suspected neutropenic fever (sNF). In order to meet the 1-hour door-to-antibiotic time target they are treated empirically with ultrabroad-spectrum antibiotics (UBSAs), before the absolute neutrophil count (ANC) is available. Studies on this treatment approach are lacking.
Objectives :
We aimed to evaluate the epidemiology, clinical presentation, infection characteristics, antibiotic patterns and outcomes in patients attending an ED with sNF.
Methodology :
Ethical approval was obtained from the local Institutional Review Board [UW21-409] to conduct a single-centre, retrospective cohort study. From 1st January 2020 to 31st December 2020, we included consecutive adult patients attending the ED at Queen Mary Hospital (QMH) with sNF. sNF was defined as body temperature ≥38.3°C at ED triage or within 24 hours before ED registration and either chemotherapy for a solid tumour within 6 weeks or a history of haematopoietic stem cell transplantation. Neutropenic Fever (NF) was defined as sNF patients with an absolute neutrophil count (ANC) < 1000/mm3. The primary outcome was 30-day all-cause mortality.
Result & Outcome :
Results: Of 95,627 ED visits reviewed in 2020, 601 (0.6%; 52.4% female; median age 62 years (IQR 53–72)) sNF patients were identified and 142 (23.6%) had confirmed NF. 364 (63.9%) patients had solid organ tumours and 243 (40.4%) had haematologic malignancies. The incidences of sNF and NF were 6.3 per 1000 attendances and 1.5 per 1000 attendances, respectively. 93% patients were prescribed Ultra-broad spectrum antibiotics (UBSAs) in the ED within one hour of registration unless contraindicated. Pathogens were identified in 35.6% of cases, with 134 (22.3%) gram-negative bacteria being the most common. Bloodstream infection was the most common 89 (14.8%) site of pathogen cultured. The 30-day, all-cause mortality rate in the NF group was 15 (10.6%) versus 43 (9.4%) in the non-NF group (χ2 test P = 0.67).
Outcome: Over 75% sNF patients received UBSAs yet did not have NF. There is a need for education on antibiotic stewardship, improved protocols, fast-track services for ANC testing and the development of a point-of-care ANC test.
