Koenig, Christa, Schneider, Christine, Morgan, Jessica E et al. (3 more authors) (2019) Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer:a systematic review. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. pp. 1-15. ISSN 1433-7339
Abstract
PURPOSE: Prompt antibiotic therapy is standard of care for patients with fever and neutropenia (FN) during chemotherapy for cancer. We systematically reviewed the association between time to antibiotics (TTA) and clinical outcomes. METHODS: The search covered seven databases; confounding biases and study quality were assessed with the ROBINS-I tool. Safety (death, intensive care unit (ICU) admission, sepsis) and treatment adequacy (relapse of infection, persistence or recurrence of fever) were assessed as primary outcomes. RESULTS: Of 6296 articles identified, 13 observational studies were included. Findings regarding safety were inconsistent. Three studies controlling for triage bias showed a possible association between longer TTA and impaired safety. Meta-analysis for TTA ≤ 60 min versus > 60 min was feasible on four studies, with three studies each reporting on death (OR 0.78, 95%CI 0.16-3.69) and on ICU admission (OR 1.43, 95%CI 0.57-3.60). No study reported data on treatment adequacy. Triage bias, i.e. faster treatment of patients with worse clinical condition, was identified as a relevant confounding factor. CONCLUSION: There seems to be an association between longer TTA and impaired safety. More knowledge about TTA effects on safety are important to optimise treatment guidelines for FN. Controlling for triage and other biases is necessary to gain further evidence. TRIAL REGISTRATION: Registration: PROSPERO [http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018092948].
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Springer-Verlag GmbH Germany, part of Springer Nature 2019. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details. |
Keywords: | Cancer,Chemotherapy,Fever,Neutropenia,Systematic review,Time to antibiotics |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Hull York Medical School (York) The University of York > Faculty of Social Sciences (York) > Centre for Reviews and Dissemination (York) |
Depositing User: | Pure (York) |
Date Deposited: | 20 Sep 2019 10:40 |
Last Modified: | 18 Mar 2025 00:08 |
Published Version: | https://doi.org/10.1007/s00520-019-04961-4 |
Status: | Published online |
Refereed: | Yes |
Identification Number: | 10.1007/s00520-019-04961-4 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:151154 |
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Filename: 2019.06.11_SR_about_TTA_and_Outcomes.docx
Description: 2019.06.11 SR about TTA and Outcomes