For adults with cancer who develop low-risk febrile neutropenia, how does outpatient treatment compare with inpatient treatment?

2019 ◽  
Author(s):  
Simone Mocellin
Keyword(s):  
Febrile Neutropenia ◽  
Outpatient Treatment ◽  
Inpatient Treatment ◽  
Low Risk

Outpatient Treatment with Intravenous Antimicrobial Therapy in Patients with Febrile Neutropenia and Hematologic Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4717-4717
Author(s):  
Marcelo Bellesso ◽  
Luis Fernando Pracchia ◽  
Lucia Dias ◽  
Dalton Chamone ◽  
Pedro Dorlhiac-Llacer
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Serum Creatinine ◽  
Pulse Oximetry ◽  
Antimicrobial Therapy ◽  
Outpatient Treatment ◽  
Laboratory Data ◽  
Hematologic Malignancies ◽  
Initial Therapy ◽  
Low Risk

Abstract OBJECTIVES: The purpose of this study is to evaluate outcomes like success of the initial therapy; failure of outpatient treatment and death in outpatient treatment with intravenous antimicrobial therapy in patients with febrile neutropenia (FN) and hematologic malignancies. In addition, it was compared clinics, laboratory data and Multinational Association for Supportive Care of Cancer index (MASCC) with failure of outpatient treatment and death. PATIENTS AND METHODS: In a retrospective study we evaluated FN following chemotherapy events that were treated initially with Cefepime, with or without Teicoplanin. RESULTS: Of the 178 FN episodes in 128 patients, it was observed success of initial therapy in 63.5% events, failure of outpatient treatment in 20.8% and death in 6.2%. In multivariate analysis, significant risks of failure of outpatient treatment were smoking (OR: 3.14, IC: 1.14 – 8.66, p=0.027) and serum creatinine > 1.2mg/dL (OR: 7.97, IC: 2.19 – 28.95, p = 0.002). About death, the risk was pulse oximetry < 95% (OR: 5.8, IC: 1.50 – 22.56, p = 0.011). Analyzing MASCC index, 165 events were classified as low risk and 13 as high-risk. Failure of outpatient treatment were reported in connection with 7 (53.8%) high-risk episodes and 30 (18.2%) low-risk, p=0.006. In addition, death in 7 (4.2%) lowrisk and 4 (30.8%) high-risk events, p=0.004. CONCLUSIONS: The outpatient treatment with intravenous antibiotic was satisfactory. The risks: smoking, serum creatinine elevated and pulse oximetry should be considered in FN evaluation. It was validated MASCC index in Brazilian population.

Retrospective study on the management of patients admitted for febrile neutropenia and considered to be at low risk at the Centre Hospitalier Universitaire de Québec.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18762-e18762
Author(s):  
Tommy Jean ◽  
Julie Lemieux ◽  
Geneviève Soucy ◽  
Francis Caron ◽  
Dominique Leblanc
Keyword(s):  
Retrospective Study ◽  
Febrile Neutropenia ◽  
Outpatient Treatment ◽  
Significant Proportion ◽  
Low Risk ◽  
University Hospital ◽  
Quebec City ◽  
Cell Transplant ◽  
Transplant Patients ◽  
Mascc Score

e18762 Background: Febrile neutropenia is a serious complication of chemotherapy leading to hospitalization in cancer patients. According to a practice guidelines published by ASCO (American Society of clinical Oncology) and IDSA (Infectious Diseases Society of American) in 2018, patients meeting the criteria for low-risk neutropenia according to the MASCC score (Multinational Association for Supportive Care in Cancer Score) could be treated as outpatient and thus avoid hospitalization. The objective of the study was to assess the number and proportion of patients who were hospitalized for febrile neutropenia in university hospital that would have met the low risk criteria of febrile neutropenia. We also wanted to know if these patients had experienced a favorable outcome during hospitalization. Methods: We performed a retrospective study including all patients admitted for febrile neutropenia in 3 hospitals in Quebec City during the period from January 1, 2018 to December 31, 2019. We excluded patients with leukemia, as well as stem cell transplant patients. The chart review retrospectively established the MASCC score for each patient. We also established according to predefined criteria whether the clinical course was favorable or unfavorable. Results: A total of 177 hospitalizations met our inclusion criteria. We found that 101/177 (57.1%) of hospitalized patients met the criteria for low-risk neutropenia according to the MASCC score (score of 21 and above). Of this number 74/177 (41.8%) presented all the criteria suggested for receiving outpatient treatment. In these patients 70/177 (39.5%) presented a favorable evolution during hospitalization and thus 4/177 (2.3%) presented an unfavorable evolution. Among these, 2 patients presented with infections considered major (2 bacteremia), 1 patient developed acute renal failure, and 1 other patient developed delirium. There was no death or admission to the intensive care unit in these 4 patients. Conclusions: According to this retrospective study, about 40% of patients admitted for febrile neutropenia filled the criteria of low risk febrile neutropenia and could be treated as outpatient. Given this represents a significant proportion of patients, a protocol for systematic follow-up of outpatient treatment with low-risk febrile neutropenia should be put in place.

scholarly journals Assessment of Utilization of Outpatient Based Treatment for Low Risk Patients with Pulmonary Embolism in Two Community Teaching Hospitals

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5779-5779
Author(s):  
Kavita Agrawal ◽  
Nirav Agrawal ◽  
Harsha Adnani ◽  
Anjali Kakwani
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Inpatient Treatment ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Low Risk ◽  
Teaching Hospitals ◽  
Outpatient Basis ◽  
Community Hospitals ◽  
Risk Patients

OBJECTIVE: Several randomized controlled trials and meta-analysis has proven safety and efficacy of outpatient based treatment in appropriately selected low-risk patients with pulmonary embolism (PE). Despite the fact that outpatient treatment has been proven safe, prior studies have shown that it is not commonly practiced. Our current multi-center study focuses on identifying practices of outpatient versus inpatient treatment of low risk PE patients in two community hospitals between 2018-2019. METHODS: A retrospective chart review of the patients in two community hospitals with the principal discharge diagnosis of pulmonary embolism aged 18 years or older was conducted. The study period included February 2018 to February 2019. The high risk patients defined as simplified pulmonary embolism severity index (PESI) score of 1 or above were excluded from the study. Low risk patients were defined as with a simplified PESI score of 0. Criteria were established to determine the appropriateness of inpatient admission for low risk patients with PE. The group of low risk patients with thrombocytopenia (platelets less than 70,000/mm3), glomerular filtration rate (GFR) of less than 30 ml/ minute, international normalized ratio (INR) greater than 1.5, pregnancy, active bleeding as documented in the medical records, total bilirubin greater than 3.0 mg/dl, extreme obesity (weight greater than 150 kg), diagnosis of acute PE while on oral anticoagulation, requiring narcotics for chest pain, need for supplemental oxygen , poor social support or presence of concomitant extensive deep vein thrombosis were deemed appropriate for inpatient treatment. The patients without these baseline characteristics were considered appropriate for outpatient treatment. RESULTS: The cohort comprised of 442 patients in two community hospitals. Among these, 172 patients had a simplified PESI score of 1 or above and were excluded from the study. The remaining 270 patients had a simplified PESI score of 0 and were considered low risk. Based on the study criteria, 54% (145 patients out of 270) of the low risk patients were deemed appropriate for outpatient treatment. Out of these, only 16% (23 patients out of 145) were treated at home. The remaining 84% (122 patients out of 145) of the low risk PE patients considered safe for outpatient treatment were actually treated as inpatient. The mean length of hospital stay for this group of patients was 3 days. Anti-coagulation therapy for those treated on outpatient basis was novel oral anticoagulants in 79% (18 patients out of 23) and low molecular weight heparin or warfarin in 21% (5 patients out of 23). CONCLUSION: Our study demonstrates that majority of low risk PE patients deemed appropriate for outpatient based treatment are treated on inpatient basis. This study shows that there is a need to implement interventions to improve practices of outpatient management of appropriately selected low-risk PE patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Outpatient Treatment for Low‐Risk Febrile Neutropenia

2019 ◽  
Vol 26 (12) ◽  
pp. 1393-1394
Author(s):  
Michael Gottlieb ◽  
Alex Koyfman ◽  
Brit Long
Keyword(s):  
Febrile Neutropenia ◽  
Outpatient Treatment ◽  
Low Risk

Single-Agent, Broad-Spectrum Fluoroquinolones for the Outpatient Treatment of Low-Risk Febrile Neutropenia

2011 ◽  
Vol 45 (9) ◽  
pp. 1094-1102 ◽  
Author(s):  
Maryann R Cooper ◽  
Cheryl R Durand ◽  
Matthew T Beaulac ◽  
Michael Steinberg
Keyword(s):  
Febrile Neutropenia ◽  
Broad Spectrum ◽  
Outpatient Treatment ◽  
Single Agent ◽  
Low Risk

Outcomes and Cost of Outpatient or Inpatient Management of 712 Patients With Febrile Neutropenia

2008 ◽  
Vol 26 (4) ◽  
pp. 606-611 ◽  
Author(s):  
Linda S. Elting ◽  
Charles Lu ◽  
Carmelita P. Escalante ◽  
Sharon H. Giordano ◽  
Jonathan C. Trent ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Statistical Tests ◽  
Signs And Symptoms ◽  
Low Risk ◽  
Outpatient Management ◽  
Single Episode ◽  
Risk Patients ◽  
Inpatient Management ◽  
The Mean ◽  
Mean Cost

Purpose We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.

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