Baseline Patient/Episode Characteristics and Outcomes Pre- and Postintervention
| Characteristic . | Preintervention (n = 83 Episodes) . | Postintervention (n = 14 Episodes) . | P Valuea . |
|---|---|---|---|
| Age, y, median (IQR) | 56 (42–66) | 51 (44–65) | .72 |
| Female sex | 35 (42) | 8 (57) | .30 |
| Malignancy | .11 | ||
| AML | 65 (78) | 9 (64) | |
| ALL | 5 (6) | 1 (7) | |
| Lymphoma | 5 (6) | 1 (7) | |
| MDS | 5 (6) | 0 (0) | |
| Other hematological malignancy | 2 (2) | 1 (7) | |
| Solid tumor | 1 (1) | 2 (14) | |
| Prior bacteremia/fungemia (same admission) | 11 (13) | 2 (14) | >.99 |
| At FN onset | |||
| FN present at admission | 27 (33) | 5 (36) | >.99 |
| CVC present | 66 (80) | 10 (71) | .49 |
| Antibacterial prophylaxis | 16 (19) | 2 (14) | >.99 |
| Antifungal prophylaxis | 53 (64) | 6 (43) | .14 |
| Therapeutic antimicrobials | 31 (37) | 3 (21) | .37 |
| Episode characteristics | |||
| Duration of FN, median (IQR) | 4 (3–5) | 3 (3–4) | .25 |
| Index organism (bacteremia/fungemia) | |||
| Streptococcus spp | 4 (5) | 1 (7) | .55 |
| Enterobacterales spp | 4 (5) | 1 (7) | .55 |
| Anaerobe | 3 (4) | 0 (0) | >.99 |
| Staphylococcus aureus | 2 (2) | 0 (0) | >.99 |
| Candida spp | 1 (1) | 1 (7) | .27 |
| Coagulase-negative Staphylococcus | 0 (0) | 1 (7) | .14 |
| Polymicrobial | 1 (1) | 0 (0) | >.99 |
| Index source | .58 | ||
| Gastrointestinal | 9 (60) | 1 (33) | |
| Catheter-related | 3 (20) | 2 (67) | |
| SSTI | 2 (13) | 0 (0) | |
| Urine | 1 (7) | 0 (0) | |
| Infectious diseases consulted | 58 (70) | 9 (64) | .76 |
| Blood culture collection | |||
| Total culture sets collected/days of FN (post–day 3; IR) | 207/146 (1.4)b | 8/12 (0.7)b | .03 |
| Days with cultures collected/days of FN (post–day 3) | 104/146 (71%)c | 4/12 (33%)c | .13 |
| Days with cultures collected/days of FN (all) | 306/395 (77%)d | 36/54 (67%)d | .39 |
| Total culture sets collected/days of FN (all; IR) | 673/4395 (1.7)e | 86/54 (1.6)e | .55 |
| Total culture sets (during admission), median (IQR) | 13 (8–18) | 10 (6–12) | .06 |
| Clinical outcomes | |||
| New-onset bacteremia/fungemia | 4 (5) | 0 (0) | >.99 |
| ICU transfer | 10 (12) | 1 (7) | >.99 |
| LOS (from start of FN episode), d, median (IQR) | 16 (11–24) | 14 (9–18) | .39 |
| In-hospital mortality | 1 (1) | 0 (0) | >.99 |
| 30-d mortality | 3 (4) | 0 (0) | >.99 |
| Characteristic . | Preintervention (n = 83 Episodes) . | Postintervention (n = 14 Episodes) . | P Valuea . |
|---|---|---|---|
| Age, y, median (IQR) | 56 (42–66) | 51 (44–65) | .72 |
| Female sex | 35 (42) | 8 (57) | .30 |
| Malignancy | .11 | ||
| AML | 65 (78) | 9 (64) | |
| ALL | 5 (6) | 1 (7) | |
| Lymphoma | 5 (6) | 1 (7) | |
| MDS | 5 (6) | 0 (0) | |
| Other hematological malignancy | 2 (2) | 1 (7) | |
| Solid tumor | 1 (1) | 2 (14) | |
| Prior bacteremia/fungemia (same admission) | 11 (13) | 2 (14) | >.99 |
| At FN onset | |||
| FN present at admission | 27 (33) | 5 (36) | >.99 |
| CVC present | 66 (80) | 10 (71) | .49 |
| Antibacterial prophylaxis | 16 (19) | 2 (14) | >.99 |
| Antifungal prophylaxis | 53 (64) | 6 (43) | .14 |
| Therapeutic antimicrobials | 31 (37) | 3 (21) | .37 |
| Episode characteristics | |||
| Duration of FN, median (IQR) | 4 (3–5) | 3 (3–4) | .25 |
| Index organism (bacteremia/fungemia) | |||
| Streptococcus spp | 4 (5) | 1 (7) | .55 |
| Enterobacterales spp | 4 (5) | 1 (7) | .55 |
| Anaerobe | 3 (4) | 0 (0) | >.99 |
| Staphylococcus aureus | 2 (2) | 0 (0) | >.99 |
| Candida spp | 1 (1) | 1 (7) | .27 |
| Coagulase-negative Staphylococcus | 0 (0) | 1 (7) | .14 |
| Polymicrobial | 1 (1) | 0 (0) | >.99 |
| Index source | .58 | ||
| Gastrointestinal | 9 (60) | 1 (33) | |
| Catheter-related | 3 (20) | 2 (67) | |
| SSTI | 2 (13) | 0 (0) | |
| Urine | 1 (7) | 0 (0) | |
| Infectious diseases consulted | 58 (70) | 9 (64) | .76 |
| Blood culture collection | |||
| Total culture sets collected/days of FN (post–day 3; IR) | 207/146 (1.4)b | 8/12 (0.7)b | .03 |
| Days with cultures collected/days of FN (post–day 3) | 104/146 (71%)c | 4/12 (33%)c | .13 |
| Days with cultures collected/days of FN (all) | 306/395 (77%)d | 36/54 (67%)d | .39 |
| Total culture sets collected/days of FN (all; IR) | 673/4395 (1.7)e | 86/54 (1.6)e | .55 |
| Total culture sets (during admission), median (IQR) | 13 (8–18) | 10 (6–12) | .06 |
| Clinical outcomes | |||
| New-onset bacteremia/fungemia | 4 (5) | 0 (0) | >.99 |
| ICU transfer | 10 (12) | 1 (7) | >.99 |
| LOS (from start of FN episode), d, median (IQR) | 16 (11–24) | 14 (9–18) | .39 |
| In-hospital mortality | 1 (1) | 0 (0) | >.99 |
| 30-d mortality | 3 (4) | 0 (0) | >.99 |
Data are presented as No. (%) unless otherwise indicated. Bold data indicate statistical significance (P ≤ .05).
Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; CVC, central venous catheter; FN, febrile neutropenia; ICU, intensive care unit; IQR, interquartile range; IR, incidence rate; LOS, length of stay; MDS, myelodysplastic syndrome; SSTI, skin and soft tissue infection.
Statistical tests performed: Wilcoxon rank-sum test, Pearson χ2 test, Fisher exact test.
Incidence rate ratio (IRR), 0.47 (95% confidence interval [CI], .23–.95).
IRR, 0.46 (95% CI, .17–1.27).
IRR, 0.86 (95% CI, .61–1.21).
IRR, 0.93 (95% CI, .74–1.17).
Baseline Patient/Episode Characteristics and Outcomes Pre- and Postintervention
| Characteristic . | Preintervention (n = 83 Episodes) . | Postintervention (n = 14 Episodes) . | P Valuea . |
|---|---|---|---|
| Age, y, median (IQR) | 56 (42–66) | 51 (44–65) | .72 |
| Female sex | 35 (42) | 8 (57) | .30 |
| Malignancy | .11 | ||
| AML | 65 (78) | 9 (64) | |
| ALL | 5 (6) | 1 (7) | |
| Lymphoma | 5 (6) | 1 (7) | |
| MDS | 5 (6) | 0 (0) | |
| Other hematological malignancy | 2 (2) | 1 (7) | |
| Solid tumor | 1 (1) | 2 (14) | |
| Prior bacteremia/fungemia (same admission) | 11 (13) | 2 (14) | >.99 |
| At FN onset | |||
| FN present at admission | 27 (33) | 5 (36) | >.99 |
| CVC present | 66 (80) | 10 (71) | .49 |
| Antibacterial prophylaxis | 16 (19) | 2 (14) | >.99 |
| Antifungal prophylaxis | 53 (64) | 6 (43) | .14 |
| Therapeutic antimicrobials | 31 (37) | 3 (21) | .37 |
| Episode characteristics | |||
| Duration of FN, median (IQR) | 4 (3–5) | 3 (3–4) | .25 |
| Index organism (bacteremia/fungemia) | |||
| Streptococcus spp | 4 (5) | 1 (7) | .55 |
| Enterobacterales spp | 4 (5) | 1 (7) | .55 |
| Anaerobe | 3 (4) | 0 (0) | >.99 |
| Staphylococcus aureus | 2 (2) | 0 (0) | >.99 |
| Candida spp | 1 (1) | 1 (7) | .27 |
| Coagulase-negative Staphylococcus | 0 (0) | 1 (7) | .14 |
| Polymicrobial | 1 (1) | 0 (0) | >.99 |
| Index source | .58 | ||
| Gastrointestinal | 9 (60) | 1 (33) | |
| Catheter-related | 3 (20) | 2 (67) | |
| SSTI | 2 (13) | 0 (0) | |
| Urine | 1 (7) | 0 (0) | |
| Infectious diseases consulted | 58 (70) | 9 (64) | .76 |
| Blood culture collection | |||
| Total culture sets collected/days of FN (post–day 3; IR) | 207/146 (1.4)b | 8/12 (0.7)b | .03 |
| Days with cultures collected/days of FN (post–day 3) | 104/146 (71%)c | 4/12 (33%)c | .13 |
| Days with cultures collected/days of FN (all) | 306/395 (77%)d | 36/54 (67%)d | .39 |
| Total culture sets collected/days of FN (all; IR) | 673/4395 (1.7)e | 86/54 (1.6)e | .55 |
| Total culture sets (during admission), median (IQR) | 13 (8–18) | 10 (6–12) | .06 |
| Clinical outcomes | |||
| New-onset bacteremia/fungemia | 4 (5) | 0 (0) | >.99 |
| ICU transfer | 10 (12) | 1 (7) | >.99 |
| LOS (from start of FN episode), d, median (IQR) | 16 (11–24) | 14 (9–18) | .39 |
| In-hospital mortality | 1 (1) | 0 (0) | >.99 |
| 30-d mortality | 3 (4) | 0 (0) | >.99 |
| Characteristic . | Preintervention (n = 83 Episodes) . | Postintervention (n = 14 Episodes) . | P Valuea . |
|---|---|---|---|
| Age, y, median (IQR) | 56 (42–66) | 51 (44–65) | .72 |
| Female sex | 35 (42) | 8 (57) | .30 |
| Malignancy | .11 | ||
| AML | 65 (78) | 9 (64) | |
| ALL | 5 (6) | 1 (7) | |
| Lymphoma | 5 (6) | 1 (7) | |
| MDS | 5 (6) | 0 (0) | |
| Other hematological malignancy | 2 (2) | 1 (7) | |
| Solid tumor | 1 (1) | 2 (14) | |
| Prior bacteremia/fungemia (same admission) | 11 (13) | 2 (14) | >.99 |
| At FN onset | |||
| FN present at admission | 27 (33) | 5 (36) | >.99 |
| CVC present | 66 (80) | 10 (71) | .49 |
| Antibacterial prophylaxis | 16 (19) | 2 (14) | >.99 |
| Antifungal prophylaxis | 53 (64) | 6 (43) | .14 |
| Therapeutic antimicrobials | 31 (37) | 3 (21) | .37 |
| Episode characteristics | |||
| Duration of FN, median (IQR) | 4 (3–5) | 3 (3–4) | .25 |
| Index organism (bacteremia/fungemia) | |||
| Streptococcus spp | 4 (5) | 1 (7) | .55 |
| Enterobacterales spp | 4 (5) | 1 (7) | .55 |
| Anaerobe | 3 (4) | 0 (0) | >.99 |
| Staphylococcus aureus | 2 (2) | 0 (0) | >.99 |
| Candida spp | 1 (1) | 1 (7) | .27 |
| Coagulase-negative Staphylococcus | 0 (0) | 1 (7) | .14 |
| Polymicrobial | 1 (1) | 0 (0) | >.99 |
| Index source | .58 | ||
| Gastrointestinal | 9 (60) | 1 (33) | |
| Catheter-related | 3 (20) | 2 (67) | |
| SSTI | 2 (13) | 0 (0) | |
| Urine | 1 (7) | 0 (0) | |
| Infectious diseases consulted | 58 (70) | 9 (64) | .76 |
| Blood culture collection | |||
| Total culture sets collected/days of FN (post–day 3; IR) | 207/146 (1.4)b | 8/12 (0.7)b | .03 |
| Days with cultures collected/days of FN (post–day 3) | 104/146 (71%)c | 4/12 (33%)c | .13 |
| Days with cultures collected/days of FN (all) | 306/395 (77%)d | 36/54 (67%)d | .39 |
| Total culture sets collected/days of FN (all; IR) | 673/4395 (1.7)e | 86/54 (1.6)e | .55 |
| Total culture sets (during admission), median (IQR) | 13 (8–18) | 10 (6–12) | .06 |
| Clinical outcomes | |||
| New-onset bacteremia/fungemia | 4 (5) | 0 (0) | >.99 |
| ICU transfer | 10 (12) | 1 (7) | >.99 |
| LOS (from start of FN episode), d, median (IQR) | 16 (11–24) | 14 (9–18) | .39 |
| In-hospital mortality | 1 (1) | 0 (0) | >.99 |
| 30-d mortality | 3 (4) | 0 (0) | >.99 |
Data are presented as No. (%) unless otherwise indicated. Bold data indicate statistical significance (P ≤ .05).
Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; CVC, central venous catheter; FN, febrile neutropenia; ICU, intensive care unit; IQR, interquartile range; IR, incidence rate; LOS, length of stay; MDS, myelodysplastic syndrome; SSTI, skin and soft tissue infection.
Statistical tests performed: Wilcoxon rank-sum test, Pearson χ2 test, Fisher exact test.
Incidence rate ratio (IRR), 0.47 (95% confidence interval [CI], .23–.95).
IRR, 0.46 (95% CI, .17–1.27).
IRR, 0.86 (95% CI, .61–1.21).
IRR, 0.93 (95% CI, .74–1.17).
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