Low adherence to febrile neutropaenia guidelines leads to hospitalization, over-prescription

A recent study has found low adherence to the febrile neutropaenia guidelines, which results in unnecessary hospital admissions of low-risk patients and over-prescription of empirical vancomycin.

The authors conducted a retrospective observational cohort study at a 60,000-visit emergency department at an academically affiliated tertiary referral hospital to assess guideline adherence and clinical outcomes associated with the management of febrile neutropenia patients. They identified patients as either low- or high-risk using the guideline-recommended Multinational Association for Supportive Care in Cancer score.

Guideline adherence referred to hospital admission and intravenous antimicrobial therapy for high-risk patients and discharge home with oral antimicrobial therapy for low-risk patients.

A total of 237 patients were included, of whom 94 (39.7 percent) were low-risk and 143 (60.3 percent) high-risk. The proportion of cases in which the management was concordant with applicable febrile neutropaenia guidelines—the primary outcome—was 96.8 percent in high-risk patients and only 0.4 percent low-risk patients.

The secondary outcome of mean hospital length of stay was 5±5.0 days in the low-risk group and 7.2±7.3 in the high-risk group. For the other secondary outcomes, Clostridium difficile occurred in 15 (10.3 percent) adherent and four (4.4 percent) nonadherent patients, and 30-day mortality occurred in four (4.3 percent) low-risk and 15 (10.7 percent) high-risk patients. In addition, 69.5 percent of high-risk patients were inappropriately administered vancomycin.

“Febrile neutropaenia is an oncologic emergency associated with significant morbidity and mortality,” according to the authors.