Empiric Antibiotic Prescribing Practice in Febrile Neutropenia: Compliance with IDSA Guidelines
Bibliographic record
Abstract
ABSTRACT Objective: To assess compliance with recommendations for empiric antibiotic therapy for febrile neutropenia, as outlined in the 1997 guidelines of the Infectious Diseases Society of America (IDSA), and to compare selected outcomes of episodes for which treatment was or was not in compliance with these guidelines. Methods: A concurrent, noninterventional chart review was conducted for 50 consecutive episodes of febrile neutropenia that occurred in 44 patients between January and May 1999 at a university-affiliated, tertiary care referral oncology centre. Empiric antibiotic therapy was assessed for compliance with IDSA guidelines. Episodes treated with compliant and noncompliant treatment regimens were compared for defervescence at 72 h and other selected clinical outcomes. Infection and response to therapy were assessed according to previously published criteria. Results: An empiric antibiotic regimen that was in compliance with the guidelines was prescribed in 28 (56%) of the 50 episodes. Patients who received such therapy were more likely than those receiving noncompliant therapy to be male (71% and 41%, p = 0.03) and to have a hematological malignancy (75% and 50%, p = 0.07). There were no significant differences between groups with respect to defervescence at 72 h, overall response to therapy, number of modifications to the antibiotic regimen, duration of empiric and total antibiotic therapy, adverse drug reactions, consultation to the infectious disease service, admission to the intensive care unit, or mortality rate. Conclusion: Because outcomes were similar in patients receiving compliant and noncompliant therapy, it appears unnecessary to implement a prescriptive policy enforcing compliance for all episodes of febrile neutropenia at this oncology centre. RESUME Objectif : Evaluer la conformite aux recommandations en matiere d’antibiotherapie empirique pour le traitement de la neutropenie febrile, telles que decrites dans les lignes directrices de 1997 de l’Infectious Diseases Society of America (IDSA), et comparer des resultats therapeutiques choisis pour les episodes pour lesquels les lignes directrices avaient ou n’avaient pas ete observees. Methodes : Une analyse simultanee non experimentale a ete menee sur les donnees de 50 episodes consecutifs de neutropenie febrile qui sont survenus chez 44 patients, entre janvier et mai 1999 a un centre de references de soins tertiaires oncologiques affilie a une universite. L’antibiotherapie empirique a ete evaluee pour observer le resultat de la conformite aux lignes directrices de l’IDSA. Les episodes pour lesquels le schema therapeutique etait ou non conforme avec les lignes directrices ont ete compares, a la recherche de signes de defervescence 72 heures apres le traitement et d’autres resultats cliniques choisis. L’infection et la reaction au traitement ont aussi ete evaluees conformement a des criteres deja publies. Resultats : L’antibiotherapie empirique conforme aux lignes directrices a ete prescrite dans 28 (56 %) des 50 episodes. Les patients qui ont recu cette antibiotherapie etaient pour la plupart, contrairement a ceux qui ont recu une antibiotherapie non conforme aux lignes directrices, des hommes (71 % vs 41 %, p = 0,03) et presentaient une affection hematologique (75 % vs 50 %, p = 0,07). Aucune difference notable entre les deux groupes n’a ete observee au chapitre de la defervescence a 72 heures, de la reponse globale au traitement, du nombre de modifications de schema therapeutique, de la duree du traitement antibiotique empirique et generalise, des reactions medicamenteuses indesirables, des consultations au service des maladies infectieuses, des admissions a l’unite des soins intensifs, ou de la mortalite. Conclusion : Etant donne que les resultats etaient semblables pour les patients qui recevaient ou non l’antibiotherapie conformement aux lignes directrices, il semble donc inutile de mettre en oeuvre une politique normative obligeant l’observance des lignes directrices pour tous les episodes de neutropenie febrile dans ce centre de soins oncologiques.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".