Feasibility of withholding antibiotics in selected febrile neutropenic cancer patients.
OBJECTIVE
To investigate the feasibility of withholding antibiotics and early discharge for patients with chemotherapy-induced neutropenia and fever at low risk of bacterial infection by a new risk assessment model.


METHODS
Outpatients with febrile neutropenia were allocated to one of three groups by a risk assessment model combining objective clinical parameters and plasma interleukin 8 level. Patients with signs of a bacterial infection and/or abnormal vital signs indicating sepsis were considered high risk. Based on their interleukin-8 level, remaining patients were allocated to low or medium risk for bacterial infection. Medium-risk and high-risk patients received standard antibiotic therapy, whereas low-risk patients did not receive antibiotics and were discharged from hospital after 12 hours of a febrile observation. End points were the feasibility of the treatment protocol.


RESULTS
Of 196 assessable episodes, 76 (39%) were classified as high risk, 84 (43%) as medium risk, and 36 (18%) as low risk. There were no treatment failures in the low-risk group (95% CI, 0% to 10%). Therefore, sensitivity of our risk assessment model was 100% (95% CI, 90% to 100%), the specificity, positive, and negative predictive values were 21%, 13%, and 100%, respectively. Median duration of hospitalization was 3 days in the low-risk group versus 7 days in the medium- and high-risk groups (P < .0001). The incremental costs of the experimental treatment protocol amounted to a saving of 471 (US $572) for every potentially low-risk patient.


CONCLUSIONS
This risk assessment model appears to identify febrile neutropenic patients at low risk for bacterial infection. Antibiotics can be withheld in well-defined neutropenic patients with fever.
Oude Nijhuis
Claudi
C
Division of Pediatric Oncology, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
Kamps
Willem A
WA
Daenen
Simon M G
SM
Gietema
Jourik A
JA
van der Graaf
Winette T A
WT
Groen
Harrie J M
HJ
Vellenga
Edo
E
Ten Vergert
Els M
EM
Vermeulen
Karin M
KM
de Vries-Hospers
Hillie G
HG
de Bont
Eveline S J M
ES
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005334:Fever / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016209:Interleukin-8; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D016209:Interleukin-8