Category: Federal Forum Posters
Purpose: Febrile neutropenia is the development of fever in patients with low numbers of neutrophil granulocytes. It results from bone marrow suppression, often associated with cancer chemotherapy side effects and the cancer itself, radiation or a combination of events. Due to the low neutrophil count, patients are at risk of life-threatening infections, and thus, the occurrence of febrile neutropenia is a medical emergency. The purpose of this study is to evaluate the current practices in the management of febrile neutropenia in the adult cancer population in Tawam Hospital, a tertiary care hospital in the United Arab Emirates.
Methods: A retrospective observational chart review for all adult cancer patients who were admitted to the Tawam hospital with a diagnosis of febrile neutropenia in the study period of January 2017 to September 2018. This study was approved by the institutional review board.
The epidemiological data of the patients were initially recorded, including age, gender, type of cancer, stage and phase/cycle of chemotherapy and the use of granulocyte colony stimulating factors (GCSF). Management protocols of febrile neutropenia were reviewed and evaluated different parameters including the; duration of treatment and hospital stay, the presence of antibiotic allergy, selection of antibiotic considering dose adjustment for renal and hepatic impairment and the need for ICU admission. The data obtained from the medical charts were used to assess the adherence of the clinicians to the international guidelines for the management of the condition.
Results: One hundred ninety nine medical charts were reviewed, and it was found that 78 patients met the inclusion criteria for having febrile neutropenia. Seventy-five patients responded to treatment and recovered while only three patients passed due to other complication of disease associated with febrile illness.
The median age of patients was 51 years old (range 18-85) with most patients (44%) were aged between 41 and 60 years old.
Forty patients (63%) were females, and 29 patients (37%) were males. Forty-six patients (59%) were found to be cancer patients with solid tumors, and 32 patients (41%) were found to have hematological malignancies. Sixty-five patients were put on filgrastim after admission (83%). The median duration of G-CSF use varied among patients with a median of 3 days (range 1-25). Piperacillin-tazobactam was the most commonly used broad spectrum antibiotic for empirical management of FN. It was administered in 72 patients (92%), fit was combined by amikacin in 18 cases. In addition, vancomycin and meropemen were used in special circumstances. The median duration of hospital admission was found to be 7 days with the longest admission time was 60 days; which was related to severe thrombocytopenia and other complications of chemotherapy.
Conclusion: Management of the FN was successful in the vast majority of patients at Tawam hospital. Clinicians followed the IDSA and NCCN guidelines recommendations. In addition, they were found to follow the local guideline, which was based on the local hospital’s antibiogram.