PROTOCOL ADHERENCE, CLINICAL CHARACTERISTICS AND TREATMENT OUTCOMES OF FEBRILE NEUTROPENIA IN A NON-ONCOLOGICAL PRIVATE HOSPITAL AT ESPIRITO SANTO

Background Febrile neutropenia (FN) is a challenging oncological emergency with potentially serious complications, especially for patients (pts) treated at non-oncological centers. Data on adherence to FN guidelines recommendations at private hospitals as well as clinical outcomes are lacking. Methods We retrospectively reviewed records of all oncologic pts with FN hospitalized in a single private center between Jul-2018 and May-2019. Linear regression was used to evaluate relationship between continuous variables, and logistic regression, when dependent variable was categorical. Fishers Exact Test and Mann-Whitney Test were used to compare categorical and continuous variables between groups, respectively. Results Twenty nine pts with FN were identified: 16 had hematological malignancies and 13 had solid tumors. Median age was 59 years; 20 pts (69%) received chemotherapy with palliative intent; 10 (34%) received regimens with high presumptive FN risk; 9 (31%) had received prophylactic granulocyte colony-stimulating factor (G-CSF). Median time from admission until prescription of antibiotics was 65 minutes (range 1382 minutes); and it did not influence duration of hospitalization (R2 0.08; P = 0.175) or intensive care unit (ICU) admission (OR 1.02; P = 0.077). Nine pts (31%) received G-CSF during the FN episode, which did not influence duration of hospitalization (P = 0.298) or time for neutrophils recovery (P = 0.124). MASCC (Multinational Association of Supportive Care in Cancer) high-risk pts had a trend towards more ICU admission (P = 0.057). Among 9 high-risk pts, 4 (44.4%) were admitted to ICU in comparison with only 2 of 20 (10%) low-risk pts. Patients treated with curative intent had longer hospitalization than those with palliative intent (median, 25 vs 7.5 days; P = 0.015). Median time of antibiotics use was 7 days, one third of pts had positive cultures, and no death related to FN occurred. Conclusion Our study showed good adherence to FN guidelines in a private non-oncologic center. Median time from pts admission to antibiotics initiation was closely accordant to international recommendations. Favorable outcomes were observed, with no death related to FN, highlighting the importance of following institutional protocols to treat these pts. Nevertheless, hospitalization of MASCC low-risk pts and use of G-CSF during the FN episode were high; and the latter did not influence duration of hospitalization or neutrophils recovery.