Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/111809 |
Resumo: | 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. |
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Rosa, Regis GoulartGoldani, Luciano ZubaranSantos, Rodrigo Pires dos2015-03-07T01:56:57Z20141471-2334http://hdl.handle.net/10183/111809000952925Background: 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.application/pdfengBMC infectious diseases. London. Vol. 2014 (May 2014), 8p.Neutropenia febrilAnti-infecciososAvaliação de programas e projetos de saúdeAdesão à medicaçãoMortalidadeFebrile neutropeniaAntimicrobial agentsChemotherapyProgram evaluationAdherenceMortalityAssociation between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort studyEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSORIGINAL000952925.pdf000952925.pdfTexto completo (inglês)application/pdf381246http://www.lume.ufrgs.br/bitstream/10183/111809/1/000952925.pdf09fc854d5fae163aeb3984151069f91bMD51TEXT000952925.pdf.txt000952925.pdf.txtExtracted Texttext/plain38082http://www.lume.ufrgs.br/bitstream/10183/111809/2/000952925.pdf.txt41331ed6b0fc9ab149089b52d3e080b3MD52THUMBNAIL000952925.pdf.jpg000952925.pdf.jpgGenerated Thumbnailimage/jpeg1904http://www.lume.ufrgs.br/bitstream/10183/111809/3/000952925.pdf.jpgbbaf1b91297fe8450f5b8eec0726f05fMD5310183/1118092023-08-17 03:35:19.423321oai:www.lume.ufrgs.br:10183/111809Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2023-08-17T06:35:19Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study |
title |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study |
spellingShingle |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study Rosa, Regis Goulart Neutropenia febril Anti-infecciosos Avaliação de programas e projetos de saúde Adesão à medicação Mortalidade Febrile neutropenia Antimicrobial agents Chemotherapy Program evaluation Adherence Mortality |
title_short |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study |
title_full |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study |
title_fullStr |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study |
title_full_unstemmed |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study |
title_sort |
Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia : a prospective cohort study |
author |
Rosa, Regis Goulart |
author_facet |
Rosa, Regis Goulart Goldani, Luciano Zubaran Santos, Rodrigo Pires dos |
author_role |
author |
author2 |
Goldani, Luciano Zubaran Santos, Rodrigo Pires dos |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Rosa, Regis Goulart Goldani, Luciano Zubaran Santos, Rodrigo Pires dos |
dc.subject.por.fl_str_mv |
Neutropenia febril Anti-infecciosos Avaliação de programas e projetos de saúde Adesão à medicação Mortalidade |
topic |
Neutropenia febril Anti-infecciosos Avaliação de programas e projetos de saúde Adesão à medicação Mortalidade Febrile neutropenia Antimicrobial agents Chemotherapy Program evaluation Adherence Mortality |
dc.subject.eng.fl_str_mv |
Febrile neutropenia Antimicrobial agents Chemotherapy Program evaluation Adherence Mortality |
description |
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. |
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2014 |
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2014 |
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2015-03-07T01:56:57Z |
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BMC infectious diseases. London. Vol. 2014 (May 2014), 8p. |
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