Variation in Antimicrobial Utilization for Febrile Neutropenia in Cancer Patients

Summary

Background: No previous study has compared hospitals with respect to the variation of antimicrobial utilization (AU) for cancer patients with febrile neutropenia (FNE).

Patients and Methods: We conducted an observational cohort study, carried out in 18 tertiary care centers across nine countries, in order to describe AU patterns for cancer patients with FNE and to evaluate whether prescription was appropriate.

Results: A total of 148 patients was exposed to 483 antimicrobial agents and 318 therapeutic courses, corresponding to 1,766 antimicrobial exposure-days. The most frequently used initial treatment consisted of a combination of a broad-spectrum β-lactam agent and an aminoglycoside (50%). The extent of initial monotherapy varied between 5% in German and 30% in French centers. Glycopeptides, fluconazole and acyclovir were incorporated into initial empiric therapy in 21, 13 and nine instances, respectively. The French centers prescribed the largest number of antimicrobial courses per FNE (mean 2.5 ± 1.5), whereas the center with the highest antimicrobial exposure density was observed in the USA (2.8 exposure-days per 1 FNE-day). AU was judged to be inappropriate by at least one criterion in 59 patients (40%).

Conclusion: This pilot study revealed important variation in AU intensity and prescription preferences in FNE patients and may help to develop appropriate strategies to improve antimicrobial therapy for this patient population.