Authors (including presenting author) :
Rainer TH(1)(2), Lam PK(1)(2), Lee SY(1), Leung SC(1), Tsang TC(2), Leung RYY(1)(2), Hung IFN(1)(2), Gill H(1), Chan WWL(1), Zhang YL(1)
Affiliation :
(1)The University of Hong Kong, Hong Kong S.A.R., China; (2)Queen Mary Hospital, Hospital Authority, Hong Kong S.A.R., China
Introduction :
In line with international guidelines, early ultrabroad-spectrum antibiotics (UBSAs) administration in patients with suspected neutropenic fever (sNF) within one hour of emergency department (ED) registration has been protocolised and implemented in all public EDs in Hong Kong since 2014.
Objectives :
We conducted a preliminary study to evaluate the feasibility of a randomised controlled trial (RCT) aiming to improve antibiotic stewardship through implementing multifaceted interventions including fast-track absolute neutrophil count.
Methodology :
This was a feasibility study with a pragmatic, parallel, two-arm RCT study design on adult cancer patients with sNF in Queen Mary Hospital. sNF was defined as a 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. NF was defined as sNF patients with an absolute neutrophil count (ANC) < 1000/mm3. Healthcare professionals received a multifaceted antibiotic stewardship intervention consisting of risk assessment tools, fast-track ANCs, a decision tool for patient management and antibiotic use supported by an educational package and staff interaction programmes (FRANCIS protocol). We evaluated the feasibility based on nine progression criteria for the target RCT, in which the primary outcome would be the median total dose of UBSAs prescribed in seven days.
Result & Outcome :
Results: From 24th October, 2022 to 20th October, 2023, 70 patients (35 controls, 35 intervention; 42/70 (60%) females; median age 61 years (IQR 54-69)) were recruited. 38/70 (54.3%) patients were recruited in the ED and 65/70 (92.9%) received UBSAs. 60/70 (85.7%) sNF patients did not have NF. Eight of the nine progression criteria were met. The mean UBSAs antibiotics use in the first seven days of hospitalisation reduced from 21 grams (SD 25) in the control group to 12 (SD 18) grams in the intervention group. The serious adverse event rate in the control group was 8/35 (22.9%) compared to 3/35 (8.6%) in the intervention group (χ2 test P=0.33).
Outcome: A modified RCT evaluating antibiotic stewardship in adult patients with sNF is feasible. The target RCT will inform health policy with improvement in safe antibiotic stewardship and early antibiotic de-escalation.
