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Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
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Low adherence to febrile neutropaenia guidelines leads to hospitalization, over-prescription

07 Oct 2020

A recent study has found low adherence to the febrile neutropaenia guidelines, which results in unnecessary hospital admissions of low-risk patients and over-prescription of empirical vancomycin.

The authors conducted a retrospective observational cohort study at a 60,000-visit emergency department at an academically affiliated tertiary referral hospital to assess guideline adherence and clinical outcomes associated with the management of febrile neutropenia patients. They identified patients as either low- or high-risk using the guideline-recommended Multinational Association for Supportive Care in Cancer score.

Guideline adherence referred to hospital admission and intravenous antimicrobial therapy for high-risk patients and discharge home with oral antimicrobial therapy for low-risk patients.

A total of 237 patients were included, of whom 94 (39.7 percent) were low-risk and 143 (60.3 percent) high-risk. The proportion of cases in which the management was concordant with applicable febrile neutropaenia guidelines—the primary outcome—was 96.8 percent in high-risk patients and only 0.4 percent low-risk patients.

The secondary outcome of mean hospital length of stay was 5±5.0 days in the low-risk group and 7.2±7.3 in the high-risk group. For the other secondary outcomes, Clostridium difficile occurred in 15 (10.3 percent) adherent and four (4.4 percent) nonadherent patients, and 30-day mortality occurred in four (4.3 percent) low-risk and 15 (10.7 percent) high-risk patients. In addition, 69.5 percent of high-risk patients were inappropriately administered vancomycin.

“Febrile neutropaenia is an oncologic emergency associated with significant morbidity and mortality,” according to the authors.

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 5 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
5 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.