Use of broad-spectrum antibiotics in adult cancer patients presenting to emergency department with non-neutropenic fever and/or suspected infection.

purposeThere is currently a lack of evidence regarding antibiotic use for adult cancer patients presenting with non-neutropenic fever. This study evaluated broad-spectrum antibiotics use among adult cancer patients who presented to the Emergency Department (ED) with non-neutropenic fever or/and suspected infection.

methodsA retrospective cohort study was completed that included adult patients with solid malignancies who presented to Juravinski Hospital ED with non-neutropenic fever or suspected infection from July 1 to December 31, 2020. The primary outcome was the proportion of patients who received one or more dose(s) of broad-spectrum antibiotics. Additionally, a multivariate logistic regression was completed to assess factors associated with an increased likelihood of clinicians prescribing broad-spectrum antibiotics.

resultsOf 275 patients analyzed, broad-spectrum intravenous antibiotics were used in 47% (109/230) of the cohort, and most of the time (78%) was the first antibiotic type given after arrival in ED. Age, gender, comorbidities, and receiving systemic treatment were not significantly associated with increased broad-spectrum antibiotic use. There were higher rates of broad-spectrum antibiotics prescribed to patients with stage IV cancer (OR 2.8, p = 0.002) and genitourinary cancer (OR 6.7, p < 0.001).

conclusionIn our single-center study, nearly half of adult cancer patients received broad-spectrum intravenous antibiotics. With a few exceptions, there was generally no consistent criteria on which clinician prescribes broad-spectrum antibiotics. These data suggest a need for quality improvement strategies to improve antibiotic stewardship for cancer patients presenting with non-neutropenic fever.