Methods: We implemented a clinical algorithm to simplify timely and effective empiric ABx and other resuscitative care to cancer outpatients with SS/SSh prior to hospital admission. Triple therapy with meropenem, tobramycin and linezolid or alternatives such as aztreonam for penicillin-allergic patients can be co-administered and provides broad coverage for resistant organisms typically encountered in this population. A pre-printed order form triggered dispensing of kits containing ABx, fluids and dexamethasone. We performed a retrospective cohort study to assess the impact of this strategy.
Results: From 1/1/08 through 1/31/12, 162 patients met inclusion criteria. Median age was 53 (IQR: 42 – 63) years and 65% were male. The majority of patients (87%) had hematopoetic malignancies. 77 (48%) were hematopoietic stem cell transplant recipients and 80 (49%) were neutropenic. SSh was diagnosed in 25 patients (15%), SS in 46 (28%), sepsis in 72 (44%) alternative diagnosis in 6 (4%) and infection without systemic inflammatory response syndrome in 13 (8%). Median time from clinical encounter to ABx administration was 114 (IQR: 60 – 179) minutes, 93% had blood cultures drawn prior to ABx, 46% received dexamethasone and 99% had crystalloid infusion started before hospital transfer. De-escalation on hospital day 1 occurred in 95% of persons admitted. 44% of 25 persons with SSh received vasopressors. 71 persons (44%) had bacteremia and 18% of 93 isolates were multidrug resistant. Possible nephrotoxicity occurred in 4 patients. 30 day mortality was 6/160 (4%) including 3/71 (4%) with SS/SSh.
Conclusion: A program to simplify choice of aggressive empiric ABx among cancer patients presenting to an ambulatory clinic with suspected sepsis was associated with unprecedented survival in those with SS/SSh, without excessive adverse events or inappropriately long empiric ABx durations.
R. Jain, None
Z. Stednick, None
M. Menon, None
S. Schwartz, None
P. Pottinger, None
C. Casper, None
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