Table 3.
Clinical Impact (Fever Episodes)
| Characteristic | Control Group (n = 672) | ECIL-4 Group (n = 695) | P Value |
|---|---|---|---|
| Type of fever | |||
| Microbiologically documented infection | 174 (25.9) | 245 (35.3) | <.001 |
| Bacteremia gram-negative | 78/174 (44.8) | 135/245 (55.1) | .038 |
| Bacteremia gram-positive | 59/174 (33.9) | 75/245 (30.6) | |
| Bacteremia coagulase-negative staphylococci | 14/174 (8.0) | 24/245 (9.8) | |
| Fungal sepsis | 9/174 (5.2) | 1/245 (0.4) | .002 |
| Pneumonia | 6/174 (3.4) | 8/245 (3.3) | |
| Proven invasive pulmonary aspergillosis | 1/174 (0.1) | 1/245 (0.1) | |
| Urinary tract infection | 6/174 (3.4) | 2/245 (0.8) | |
| Clinically documented infection | 168 (25.0) | 161 (23.2) | |
| Pneumonia | 104/168 (61.9) | 88/161 (54.7) | |
| Possible invasive pulmonary aspergillosis | 24/168 (14.3) | 21/161 (13.0) | |
| Probable invasive pulmonary aspergillosis | 25/168 (14.9) | 20/161 (12.4) | |
| (Entero)colitis | 26/168 (15.5) | 36/161 (22.4) | |
| Skin/soft tissue infection | 18/168 (10.7) | 7/161 (4.3) | |
| Oral cavity/dental abscess | 6/168 (3.6) | 10/161 (6.2) | |
| Sinusitis | 6/168 (3.6) | 3/161 (1.9) | |
| Fever of unknown origin | 330 (49.1) | 289 (41.6) | .005 |
| Time to defervescence, d, median (range) | 2 (1–23) | 2 (1–20) | .001 |
| Severe sepsis | 51 (7.6) | 51 (7.3) | |
| Septic shock | 25 (3.7) | 21 (3.0) | |
| Infection-related ICU admission | 21 (3.1) | 23 (3.3) | |
| Compliance with stewardship SOP flowchart (when applicable) | |||
| Microbiologically documented infection | … | 179/195 (91.8) | |
| Clinically documented infection | … | 120/127 (94.5) | |
| Fever of unknown origin | … | 215/260 (82.7) | |
| Antibiotic discontinuation prior to neutrophil recovery | 91 (13.5) | 289 (41.6) | <.001 |
| Microbiologically documented infection | 14/174 (18.9) | 75/245 (30.6) | |
| Duration of antibiotic therapy, d, median (range) | 9.5 (5–14) | 7 (5–21) | |
| Antibiotic days saved, d, median (range) | 1 (0–8) | 4 (0–22) | |
| Clinically documented infection | 15/168 (8.9) | 54/161 (33.5) | |
| Duration of antibiotic therapy, d, median (range) | 10 (6–17) | 8 (4–15) | |
| Antibiotic days saved, d, median (range) | 4 (3–7) | 3.5 (1–10) | |
| Fever of unknown origin | 62/330 (18.8) | 160/289 (55.4) | |
| Duration of antibiotic therapy, d, median (range) | 9 (3–17) | 5 (0–19) | |
| Antibiotic days saved, d, median (range) | 3 (0–12) | 5 (0–19) | |
| Recurrent fever | |||
| Overall | 233/672 (34.7) | 289/695 (41.6) | .009 |
| After discontinuation prior to neutrophil recovery | 49/91 (53.8) | 153/289 (52.9) | |
| While still on antibiotics prior to neutrophil recovery | 184/589 (31.7) | 136/406 (33.5) | |
| Cause of recurrent fever after discontinuation | |||
| Microbiologically documented infection—same as before | 1/49 (2.0) | 6/153 (3.9) | |
| Microbiologically documented infection—different | 20/49 (40.8) | 67/153 (43.8) | |
| Clinically documented infection—same as before | 2/49 (4.1) | 6/153 (3.9) | |
| Clinically documented infection—different | 11/49 (22.4) | 27/153 (17.6) | |
| Fever of unknown origin | 15/49 (30.6) | 47/153 (30.7) | |
Data are presented as No. (%) unless otherwise indicated.
Abbreviations: ECIL-4, Fourth European Conference on Infections in Leukaemia; ICU, intensive care unit; SOP, standard operating procedure.