title: Impact of time to antibiotics on outcomes of chemotherapy-induced febrile neutropenia.
abstract: OBJECTIVE
  The aim of this study was to determine the relationship between the time to antibiotic administration and patients' outcomes of febrile neutropenia (FN). We also investigated the relationship between the time to antibiotics and mortality rates in a subgroup of patients with bacteremia or severe sepsis or septic shock.
  
  
  METHODS
  From the Neutropenic Fever Registry, we analyzed 1001 consecutive FN episodes diagnosed from November 1, 2011, to August 31, 2014. Timing cutoffs for antibiotics included the following: ≤1 vs. >1 h, ≤2 vs. >2 h, ≤3 vs. >3 h, and ≤4 vs. >4 h. Multivariate logistic regression was used to adjust for potential confounders in the association between timing intervals and outcomes of FN episodes.
  
  
  RESULTS
  The median length of time from triage to antibiotics was 140 min (interquartile range, 110-180 min). At each time cutoff, the time from triage to antibiotic administration was not significantly associated with FN outcomes after adjusting for potential confounders. Antibiotic timing was not significantly associated with complication rates in overall FN episodes. We failed to find a significant relationship between antibiotic timing and mortality in FN episodes with severe sepsis or septic shock or with bacteremia. Procalcitonin concentration and the Multinational Association for Supportive Care in Cancer (MASCC) risk index score were found to be more crucial determinants of outcomes in patients with FN.
  
  
  CONCLUSIONS
  The time to antibiotic administration is not a major factor in FN outcomes.
authors: Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
authors: Byuk Sung
authors: BS
authors: Ko
authors: Shin
authors: S
authors: Ahn
authors: Yoon-Seon
authors: YS
authors: Lee
authors: Won Young
authors: WY
authors: Kim
authors: Kyung Soo
authors: KS
authors: Lim
authors: Jae-Lyun
authors: JL
authors: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D011498:Protein Precursors / Q000097:blood; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014218:Triage
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide