| Primary Author: | Kathy McCarthy, BSN, RN |
| Co-Principal Investigators/Collaborators: | Patricia Baxter, Mona McPherson, Deborah Palazzi, Andras Heczey, Marilyn J. Hockenberry |
| Organization: | Baylor College of Medicine |
Abstract
Background
Supportive care guidelines based on best evidence play a significant role in improving care for children experiencing fever and neutropenia (FN) during cancer treatment. A review found patients were at risk for acute renal toxicity during treatment for FN. This raised concern for the risks versus benefits of high-risk cancer patients receiving gentamicin as part of the empirical therapy for FN. Therefore, our children’s cancer center revised our evidence-based guideline (EBG) for treating high-risk patients without symptoms of septic shock with vancomycin and piperacillin/tazobactam combination excluding gentamicin.
Purpose
To evaluate safety and outcomes of the revised EBG by a quality improvement task force. Outcomes included: no empirical use of gentamicin for high-risk patients without symptoms of septic shock, no increase in patients transferred to PICU in the first 72 hours of therapy, and decreased risk of renal toxicity demonstrated by stable serum creatinine levels in the first 72 hours of therapy.
Methods
Ninety-seven patients receiving chemotherapy for cancer that had moderate/severe neutropenia (ANC < 500) and fever were evaluated during the first 72 hours of antibiotic therapy. Antibiotics administered, EBG adherence, transfers to PICU and serum creatinine levels were prospectively monitored.
Results
A total of 97 patients were evaluated. Eighty-eight percent of patients without signs or symptoms of septic shock initially received vancomycin and piperacillin/tazobactam in accordance with the EBG. Patients on the revised EBG, when compared to 76 historical controls who received gentamicin as part of empirical therapy, demonstrated less change in serum creatinine levels in the first 72 hours of antibiotics (t=4.249 (df 86), p < .001). Patient transfers to PICU were reduced compared to the previous year (3 [3%] vs. 11 [14%]).
Conclusion
Standardizing clinical practice using an EBG minimizes variation in care and improves the quality and safety of care for pediatric cancer patients. Treatment of high risk cancer patients with FN is safe and effective without the use of empiric aminoglycosides in this population.
© Improvement Science Research Network, 2011