title: Prospective audit of febrile neutropenia management at a tertiary university hospital in Singapore.
abstract: BACKGROUND
  Febrile neutropenia (FN) remains a major cause of morbidity and mortality in Oncology/Haematology units. We launched a new protocol for FN management that incorporates risk stratification at our institute from October 2008. An audit was performed concurrently to evaluate the protocol and to define the epidemiology of FN locally.
  
  
  METHODS
  Case records of all inpatients with FN between October 2008 and June 2009 were reviewed prospectively. Clinical and microbiological characteristics were collated along with outcomes and programme adherence. Statistical testing was performed using Stata 10.1.
  
  
  RESULTS
  There were 178 FN episodes (50 in patients with solid cancers) from 131 patients. Forty-two (23.6%) episodes were classified as high-risk according to MASCC criteria. Initial blood cultures were positive in 49 (27.5%) episodes, of which gram-negative bacilli (GNB) predominated. Overall compliance to the protocol was 56.7%, with the main issue being disinclination to use oral antibiotics as fi rst-line empirical therapy for low-risk episodes. Overall mortality was 7.3% and infection-related mortality was 4.5%. High-risk FN and the presence of central venous catheters were independently associated with bacteraemia on multivariate analysis, but there were no independent predictors of infection-related mortality.
  
  
  CONCLUSIONS
  GNB accounted for the majority of bloodstream infections at our institute, unlike data from developed countries. Uptake of the new FN protocol was satisfactory, although the use of oral antibiotics as fi rst-line empirical therapy can be improved. A better method for predicting infections caused by antibiotic-resistant GNB is urgently required, and antibiotic resistance trends should be monitored to enable the implementation of more appropriate antibiotic regimens over time.
authors.affiliation: Office of Biomedical Research, National University Hospital, Singapore.
authors.forename: Jing
authors.initials: J
authors.lastname: Jin
authors.forename: Yee Mei
authors.initials: YM
authors.lastname: Lee
authors.forename: Ying
authors.initials: Y
authors.lastname: Ding
authors.forename: Liang Piu
authors.initials: LP
authors.lastname: Koh
authors.forename: Siew Eng
authors.initials: SE
authors.lastname: Lim
authors.forename: Robert
authors.initials: R
authors.lastname: Lim
authors.forename: Paul Ananth
authors.initials: PA
authors.lastname: Tambyah
authors.forename: Li Yang
authors.initials: LY
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004352:Drug Resistance, Microbial; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000503:physiopathology; D006090:Gram-Negative Bacteria; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D012846:Singapore; D055815:Young Adult