title: Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study.
abstract: BACKGROUND
  Initial management of chemotherapy-induced febrile neutropaenia (FN) comprises empirical therapy with a broad-spectrum antimicrobial. Currently, there is sufficient evidence to indicate which antibiotic regimen should be administered initially. However, no randomized trial has evaluated whether adherence to an antimicrobial stewardship program (ASP) results in lower rates of mortality in this setting. The present study sought to assess the association between adherence to an ASP and mortality among hospitalised cancer patients with FN.
  
  
  METHODS
  We conducted a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All adult patients who were admitted to the haematology ward with cancer and FN were followed up for 28 days. ASP adherence to the initial antimicrobial prescription was determined. The mortality rates of patients who were treated with antibiotics according to the ASP protocol were compared with those of patients treated with other antibiotic regimens. The multivariate Cox proportional hazards model and propensity score were used to estimate 28-day mortality risk.
  
  
  RESULTS
  A total of 307 FN episodes in 169 subjects were evaluated. The rate of adherence to the ASP was 53%. In a Cox regression analysis, adjusted for propensity scores and other potential confounding factors, ASP adherence was independently associated with lower mortality (hazard ratio, 0.36; 95% confidence interval, 0.14-0.92).
  
  
  CONCLUSIONS
  Antimicrobial selection is important for the initial management of patients with FN, and adherence to the ASP, which calls for the rational use of antibiotics, was associated with lower mortality rates in this setting.
authors.forename: Regis G
authors.initials: RG
authors.lastname: Rosa
authors.affiliation: Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Room 2225, PO Box 90035-903, Porto Alegre, RS, Brazil. lgoldani@ufrgs.br.
authors.forename: Luciano Z
authors.initials: LZ
authors.lastname: Goldani
authors.forename: Rodrigo P
authors.initials: RP
authors.lastname: dos Santos
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000188:drug therapy; D015331:Cohort Studies; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D017410:Practice Guidelines as Topic; D055656:Prescriptions; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents