Internal medicine journal · 2025
An Australasian survey of clinical practices in management of neutropenic fever in adult cancer patients 2023.
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Singh Nikhil, Lingaratnam Senthil, Haeusler Gabrielle M, Slavin Monica A, Douglas Abby P, Thursky Karin A
Аннотация
BACKGROUND: Neutropenic fever (NF) is a common complication of systemic anti-cancer therapy requiring prompt management. A previous 2009 Australian survey of NF clinical practices identified evidence-practice gaps that informed the 2011 Australian Consensus Guidelines for the Management of Neutropenic Fever in Adult Cancer Patients. The emergence of novel cancer therapies and evidence for risk-stratified NF treatment warrant re-evaluation of current approaches to management.
AIMS: To describe current clinical practices in Australia and New Zealand in adult NF management, compare results to the 2009 survey, and identify areas for improvement.
METHODS: An electronic survey was distributed to haematology, oncology, and infectious diseases clinicians across Australia and New Zealand between June and August 2023. Survey domains included risk stratification, empiric treatment, use of prophylaxis, and management of patients colonised with multidrug-resistant organisms. Descriptive analyses compared responses between specialties and to 2009 data.
RESULTS: A total of 132 clinician responses were received. Improvements were observed in the appropriateness of empiric treatment of NF with a reduction in the use of dual therapy and prescribing of antibacterial prophylaxis. However, knowledge of risk stratification and utilisation of ambulatory care for low-risk NF remained low. Heterogeneity in empiric antibiotic duration and management of patients colonised with multi-drug resistant organisms was observed. Infectious diseases involvement remained widespread but decreased among the medical oncology cohort between 2009 and 2023.
CONCLUSIONS: While practices have evolved, critical gaps in risk assessment, appropriateness for early discharge, and antimicrobial stewardship remain. Investments in infrastructure, education and multidisciplinary collaboration are essential to improve the uptake of ambulatory care models for NF. The updated consensus guidelines have addressed ambulatory care, antimicrobial duration and empiric management of those colonised with resistant organisms.
AIMS: To describe current clinical practices in Australia and New Zealand in adult NF management, compare results to the 2009 survey, and identify areas for improvement.
METHODS: An electronic survey was distributed to haematology, oncology, and infectious diseases clinicians across Australia and New Zealand between June and August 2023. Survey domains included risk stratification, empiric treatment, use of prophylaxis, and management of patients colonised with multidrug-resistant organisms. Descriptive analyses compared responses between specialties and to 2009 data.
RESULTS: A total of 132 clinician responses were received. Improvements were observed in the appropriateness of empiric treatment of NF with a reduction in the use of dual therapy and prescribing of antibacterial prophylaxis. However, knowledge of risk stratification and utilisation of ambulatory care for low-risk NF remained low. Heterogeneity in empiric antibiotic duration and management of patients colonised with multi-drug resistant organisms was observed. Infectious diseases involvement remained widespread but decreased among the medical oncology cohort between 2009 and 2023.
CONCLUSIONS: While practices have evolved, critical gaps in risk assessment, appropriateness for early discharge, and antimicrobial stewardship remain. Investments in infrastructure, education and multidisciplinary collaboration are essential to improve the uptake of ambulatory care models for NF. The updated consensus guidelines have addressed ambulatory care, antimicrobial duration and empiric management of those colonised with resistant organisms.