Table 5.
Antimicrobial Utilization During Febrile Neutropenia Admissionsa
| High-Risk (n = 675 FN Admissions) | Standard-Risk (n = 713 FN Admissions) | |||||
|---|---|---|---|---|---|---|
| Pre- Intervention | Post- Intervention | Pre- Intervention | Post- Intervention | |||
| (2009–2011) | (2013–2015) | (2009–2011) | (2013–2015) | |||
| Antimicrobial data elements | n = 340 | n = 335 | P Valueb,c | n = 357 | n = 356 | P Valueb,c |
| Total FN days | 4251 | 4497 | – | 1975 | 1776 | – |
| Total DOT (all antibiotics) per 1000 FN daysb | 2296.6 | 1758.1 | <.001 | 2940.8 | 2931.9 | .87 |
| Total DOT (all nonprophylaxis) per 1000 FN daysb | 1922.1 | 1424.5 | <.001 | 2176.2 | 2207.2 | .52 |
| Total empiric DOT (all antibiotics) per 1000 FN daysb | 1388.4 | 972.9 | <.001 | 1475.9 | 1554.1 | .05 |
| Intravenous vancomycin | ||||||
| Any use, n (%)c | 178 (52) | 250 (75) | <.001 | 112 (31) | 85 (24) | .03 |
| Total DOT/1000 FN daysb | 435.0 | 295.8 | <.001 | 324.6 | 224.1 | <.001 |
| Empiric use, n (%)c | 139 (41) | 228 (68) | <.001 | 69 (19) | 61 (17) | .45 |
| Empiric DOT/1000 FN daysb | 315.2 | 199.2 | <.001 | 164.6 | 115.4 | <.001 |
| Oral vancomycin | ||||||
| Any use, n (%)c | 5 (1) | 8 (2) | .39 | 9 (3) | 7 (2) | .62 |
| Total DOT/1000 FN daysb | 56.2 | 34.9 | <.001 | 64.8 | 60.8 | .63 |
| Empiric use, n (%)c | 0 (0) | 1 (<1) | .50 | 0 (0) | 0 (0) | – |
| Empiric DOT/1000 FN daysb | 0 | 2 | .99 | 0 | 0 | – |
| Third- and fourth-generation cephalosporinsd | ||||||
| Any use, n (%)c | 268 (79) | 240 (72) | .03 | 288 (81) | 324 (91) | <.001 |
| Total DOT/1000 FN daysb | 699.6 | 516.3 | <.001 | 730.1 | 948.2 | <.001 |
| Empiric use, n (%)c | 256 (75) | 221 (66) | .008 | 280 (78) | 312 (88) | .001 |
| Empiric DOT/1000 FN daysb | 623.9 | 437.8 | <.001 | 678 | 1108.7 | <.001 |
| Anaerobic agentse | ||||||
| Any use, n (%)c | 109 (32) | 123 (37) | .20 | 78 (22) | 81 (23) | .77 |
| Total DOT/1000 FN daysb | 304.6 | 401.4 | <.001 | 283.5 | 283.8 | .99 |
| Empiric use, n (%)c | 90 (26) | 101 (30) | .29 | 65 (18) | 58 (16) | .50 |
| Empiric DOT/1000 FN daysb | 196.7 | 263.3 | <.001 | 177.2 | 145.3 | .02 |
Abbreviations: DOT, antibiotic days of therapy; FN, febrile neutropenia
aN = 1388 admissions.
b P value from Poisson regression testing for difference in DOT per 1000 episode-days by period within risk category.
c P value from χ2 test to test for difference in antibiotic use by period within risk category for any use (%) and empiric use (%).
dIncludes ceftriaxone, ceftazidime, and cefepime.
eIncludes metronidazole, piperacillin/tazobactam, and meropenem.