Predictor Factors of Empirical Antibiotic Escalation in Hematological Malignancies Patients with First Episode Febril Neutropenia at Dr. Sardjito Hospital, Yogyakarta, Indonesia

Background

Neutropenic fever is an oncology emergency. The incidence of neutropenic fever in hematological malignancies patients is 80%, with a mortality rate of up to 10%. Broad-spectrum empirical antibiotics must be promptly administered to reduce mortality rate and complications. The selection of empirical antibiotic types should consider the possible causative pathogens based on local microbial patterns. Antibiotic escalations are one of the indicators of empirical antibiotic failure, which is quite common in patients with febrile neutropenia in hematological malignancies.

Aim: To determine predictor factors of empirical antibiotic escalation in patients with hematological malignancies with the first episode of febrile neutropenia.

Method

A retrospective cohort study was conducted in patients with febrile neutropenia in hematological malignancies at Sardjito Hospital Yogyakarta between January 2018-December 2022, samples were selected by consecutive sampling. Bivariate analysis was performed using Chi-square test, independent variables with p-value < 0.25 continued to multivariate analysis using the logistic regression test with a significance value of p < 0.05. The strength of associations was determined using adjusted odds ratios (aOR) and 95% confidence intervals (CIs).

Results

A total of 397 patients with first-episode febrile neutropenia in hematological malignancies were treated during the study period. Among them, 223 subjects met the inclusion criteria, and 61 (27.4%) subjects experienced empirical antibiotic escalation. Multivariate analysis showed that pneumonia as a source of focal infection (p 0.003; aOR 3.09; 95% CI 1.46-6.56) was a significant predictor factor of empirical antibiotic escalation in hematology.

Conclusion

Pneumonia is a predictor factor of empirical antibiotic escalation in hematological malignancies patients with the first episode of febrile neutropenia.