OP-056 The impact of time to antibiotic administration in febrile neutropenia

Aim Febrile neutropenia (FN) is a common cause of mortality and morbidity in children with cancer, which necessitates prompt antibiotherapy. Antibiotic administration within one hour is recommended and accepted as a quality-of-care measure in developed countries. The goal of this study is to assess the impact of time to antibiotic administration (TTA) on the prognosis of febrile neutropenia in children treated for cancer in Istanbul. Material and Method The patients with chemotherapy-associated FN between the ages of 1 month and 18 years in our center were prospectively recruited. TTA was recorded as the time from the beginning of FN symptoms to hospital admission (TTA1), the time from hospital admission to antibiotic initiation (TTA2), and the time from the beginning of FN symptoms to antibiotic initiation (TTA3). We also examined the correlation between treatment failure and TTA as well as other study variables of FN. Results Eighty-one FN episodes in 40 patients were included. The median values for TTA1, TTA2, and TT3 were 176, 120, and 195 minutes, respectively. TTA was found to be ≤60 minutes only in 16% of the episodes. Hospitalized patients or cases without a defined focus of infection had a greater rate of antibiotic initiation within an hour. The median TTA initiation was substantially shorter in treatment-failed episodes. Conclusions Surprisingly, patients who received antibiotics faster had a higher rate of treatment failure, contrary to expectations. The unfavorable clinical and laboratory characteristics seen at admission in our study may be the cause. In addition, our study's TTA was longer than recommended in current guidelines. Real-life data and idealized situations differed significantly from each other, and this discrepancy was ascribed to large metropolitan centers' traffic-related delays. Educational programs for both families and healthcare professionals are recommended to optimize TTA and, consequently, improve outcomes in febrile neutropenia.