Christa Koenig1,2, Christine Schneider3, Jessica E Morgan4,5, Roland A Ammann3, Lillian Sung6, Bob Phillips4,5. 1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland. christa.koenig@insel.ch. 2. Centre for Reviews and Dissemination, University of York, York, UK. christa.koenig@insel.ch. 3. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland. 4. Centre for Reviews and Dissemination, University of York, York, UK. 5. Leeds Children's Hospital, Leeds, UK. 6. The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Abstract
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].
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].
Entities:
Keywords:
Cancer; Chemotherapy; Fever; Neutropenia; Oncology; Systematic review; Time to antibiotics
Authors: Charles Lim; Jaime Bawden; Andrew Wing; Cristina Villa-Roel; David P Meurer; Michael J Bullard; Brian H Rowe Journal: Am J Emerg Med Date: 2010-10-27 Impact factor: 2.469
Authors: Lisa M Daniels; Urshila Durani; Jason N Barreto; John C O'Horo; Mustaqeem A Siddiqui; John G Park; Pritish K Tosh Journal: Support Care Cancer Date: 2019-02-25 Impact factor: 3.603
Authors: Allison R Butts; Christina Carracedo Bachmeier; Emily V Dressler; Meng Liu; Ann Cowden; Jeff Talbert; Val R Adams Journal: J Oncol Pharm Pract Date: 2017-01-11 Impact factor: 1.809
Authors: M van Vliet; C M J Potting; P D J Sturm; J P Donnelly; N M A Blijlevens Journal: Eur J Cancer Care (Engl) Date: 2011-07-19 Impact factor: 2.520
Authors: Miriam L Gonzalez; Paula Aristizabal; Adriana Loera-Reyna; Dara Torres; Mario Ornelas-Sánchez; Laura Nuño-Vázquez; Marco Aguilera; Alicia Sánchez; Mitzy Romano; Rebeca Rivera-Gómez; George Relyea; Paola Friedrich; Miguela A Caniza Journal: JCO Glob Oncol Date: 2021-05
Authors: Max Scheler; Thomas Lehrnbecher; Andreas H Groll; Ruth Volland; Hans-Jürgen Laws; Roland A Ammann; Philipp Agyeman; Andishe Attarbaschi; Margaux Lux; Arne Simon Journal: Infection Date: 2020-06-10 Impact factor: 3.553
Authors: Demis N Lipe; Sorayah S Bourenane; Monica K Wattana; Susan Gaeta; Patrick Chaftari; Maria T Cruz Carreras; Joanna-Grace Manzano; Cielito Reyes-Gibby Journal: Am J Emerg Med Date: 2022-02-05 Impact factor: 4.093
Authors: Christa Koenig; Claudia E Kuehni; Nicole Bodmer; Philipp K A Agyeman; Marc Ansari; Jochen Roessler; Nicolas X von der Weid; Roland A Ammann Journal: Sci Rep Date: 2022-08-18 Impact factor: 4.996