Assessment of Antimicrobial Utilization among Cancer Patients with Febrile Neutropenia at the Lebanese Hospitals

Abstract

Background: Febrile neutropenia is a prevalent oncologic complication. Initiating rapid treatment with empirical antimicrobials in febrile neutropenia patients reduces mortality due to infections.

Objectives: The study aims to evaluate antimicrobial utilization among FN patients in Lebanon in terms of drug choice, dose, and duration of treatment.

Setting: This is a retrospective, multicenter, observational study was conducted at three different Lebanese university hospitals (in which the Infectious Diseases Society of America (IDSA) guidelines are adopted), between February 2014 and May 2017.

Methods: Adult cancer patients aged 18 years and older with febrile neutropenia were included in the study. Using the IDSA guidelines as a reference, patients were assessed whether they received the antimicrobial regimen in consistent to the IDSA reference or not. Statistical analysis was performed using the Statistical Package for the Social Science software (SPSS version 22.0).

Main outcome measure: The adherence to guidelines for the indication and doses of antibiotics and anti-fungal in patients with febrile neutropenia.

Results: A total of 124 patients with a mean age of 54.43±17.86 years were enrolled in the study. Leukemia (29.7%) was the most prevalent cancer and the most common infection was sepsis (20.2%). Combination antibiotic lactams being the most prescribed antibiotics (86.8%). Only 94 (86.23%) patients were given the antibiotic therapy appropriate for choice, dose, and duration. Empirical antifungal therapy was initiated in 63.7% of the patients and fluconazole was the most used antifungal (36.3%). In contrast to antibiotics, the majority of antifungal choices were not selected according to the recommendations and they were considered inappropriate for doses and for the required treatment duration as proposed by (IDSA). Fifty-eight percent of patients received antivirals, even though it is not recommended as empirical treatment.

Conclusion: In conclusion, this study reveals a non-consistent antimicrobial utilization practice at the involved sites with respect to FN treatment. Inappropriateness was encountered in drug selection, dose and duration of treatment with antifungals and antivirals.