Time to antibiotic administration in children with febrile neutropenia: Report from a low middle-income country

BACKGROUND & OBJECTIVES: Antibiotic administration within one hour of presentation is a standard of care goal in the treatment of febrile neutropenia (FN). The objective of this study was to find the proportion of children with FN who had a time to antibiotic administration (TTA) of ≤60 min and evaluate causes for delay. METHODS: A prospective analysis of children presenting with FN was carried out. The primary outcome was the proportion of patients who received antibiotics within one hour of triage. Predictor variables included the place of presentation, time and day of the week. A root cause analysis was done for delayed TTA. RESULTS: A total of 211 children (mean age: 6 yr) with FN were evaluated for TTA. The primary outcome of TTA, (≤60 min) was achieved in 66 per cent children. The odds of delayed TTA were lower when patients were evaluated in the night. Odds of delayed TTA were higher in patients who had no focus of infection, when assessed in the oncology daycare and when assessed over the weekend, but none were statistically significant. Waiting for blood results (30%), delay in preparing antibiotics (21%) and delay in allotting bed (30%) were significant causes for delay. INTERPRETATION & CONCLUSIONS: Two-thirds of the patients achieved the target TTA of ≤60 min. Patients seen during the daytime and on weekends had a delay in TTA compared to those presenting at the evening or night or weekdays. Children with a focus for fever received antibiotics earlier. Logistics for admission and awaiting blood counts were chief causes for delay.