Timely Management of Febrile Neutropenia in Children with Cancer — ASN Events

Timely Management of Febrile Neutropenia in Children with Cancer (#295)

Aditi Vedi 1 , Richard J Cohn 1 , Victoria Pennington 1 , Matthew O'Meara 1 , Kylie Stark 1 , Paul Hunstead 1 , Kirsten Adnum 1 , Wendy Londal 1 , Anne Senner 1 , Lucy Maurice 1 , Allan James , Brent O'Carrigan 1
  1. Sydney Children's Hospital, Randwick, NSW, Australia

Sepsis is a major cause of morbidity and mortality in paediatric oncology patients, particularly during periods of neutropenia. The current international standard of care is recognised as rapid assessment and delivery of empiric antibiotics within one hour of onset of fever, for all febrile and potentially neutropenic patients1,2 .

Although paediatric oncology services are centralised to tertiary hospitals in Australia, peripheral centres provide supportive care for this immunosuppressed group of patients close to home, in a “shared-care” model.

The objective of this study was to ensure delivery of empiric antibiotics to all children with fever and suspected neutropenia within one hour of presentation to tertiary and peripheral hospitals. We expected to observe this outcome within 12 months of implementation of an intervention and a sustained response after 5 years.


The records of all oncology patients presenting to an emergency department over a 3 month period were reviewed and time to first antibiotic administration recorded. Potential causes of delay in commencement of antibiotics were identified through focus groups and a questionnaire involving patients, medical and nursing staff. These were evaluated to develop a management guideline. The introduction of this practice change was supported by staff education. Follow- up data was collected at 12 and 60 months post intervention.


The median time to empiric antibiotics was reduced from 180 minutes to 75 minutes at 12 months post intervention and the results were sustained at 5 years, with the median time being 65 minutes.


12 months

60 months

Number of patients

N = 24

N = 20

N= 35

Median time to first empiric antibiotic

150 min

75 min

65 min

Proportion receiving antibiotics within 1 hour





The introduction of the guideline has resulted in an improvement in practice, meeting international guidelines with sustained results at 5 years after introduction at a tertiary and secondary hospital.

  1. Amado VM, Vilela GP, Queiroz A, Jr., Amaral AC. Effect of a quality improvement intervention to decrease delays in antibiotic delivery in pediatric febrile neutropenia: a pilot study. J Crit Care 2011;26:103 e9-12.
  2. Baltic T, Schlosser E, Bedell MK. Neutropenic fever: one institution's quality improvement project to decrease time from patient arrival to initiation of antibiotic therapy. Clinical journal of oncology nursing 2002;6:337-40