Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer: a systematic review.

Koenig, Christa; Schneider, Christine; Morgan, Jessica E.; Ammann, Roland A.; Sung, Lillian; Phillips, Bob (2020). Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer: a systematic review. Supportive care in cancer, 28(3), pp. 1369-1383. Springer-Verlag 10.1007/s00520-019-04961-4

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PURPOSE Prompt antibiotic therapy is standard of care for patients with fever and neutropenia (FN) during chemotherapy for cancer. We systematically reviewed the association between time to antibiotics (TTA) and clinical outcomes. METHODS The search covered seven databases; confounding biases and study quality were assessed with the ROBINS-I tool. Safety (death, intensive care unit (ICU) admission, sepsis) and treatment adequacy (relapse of infection, persistence or recurrence of fever) were assessed as primary outcomes. RESULTS Of 6296 articles identified, 13 observational studies were included. Findings regarding safety were inconsistent. Three studies controlling for triage bias showed a possible association between longer TTA and impaired safety. Meta-analysis for TTA ≤ 60 min versus > 60 min was feasible on four studies, with three studies each reporting on death (OR 0.78, 95%CI 0.16-3.69) and on ICU admission (OR 1.43, 95%CI 0.57-3.60). No study reported data on treatment adequacy. Triage bias, i.e. faster treatment of patients with worse clinical condition, was identified as a relevant confounding factor. CONCLUSION There seems to be an association between longer TTA and impaired safety. More knowledge about TTA effects on safety are important to optimise treatment guidelines for FN. Controlling for triage and other biases is necessary to gain further evidence. TRIAL REGISTRATION Registration: PROSPERO [http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018092948].

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Paediatric Haematology/Oncology

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

König, Christa; Schneider, Christine and Ammann, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0941-4355

Publisher:

Springer-Verlag

Language:

English

Submitter:

Roland Ammann

Date Deposited:

24 Jan 2020 15:55

Last Modified:

01 Feb 2020 01:33

Publisher DOI:

10.1007/s00520-019-04961-4

PubMed ID:

31264188

Uncontrolled Keywords:

Cancer Chemotherapy Fever Neutropenia Oncology Systematic review Time to antibiotics

BORIS DOI:

10.7892/boris.137522

URI:

https://boris.unibe.ch/id/eprint/137522

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