Febrile neutropenia is a complication of cancer treatment that can result in life-threatening infections. Guidelines recommend empiric use of vancomycin in febrile neutropenia for patients with specific risk factors for gram-positive infection. The purpose of this study is to evaluate the guideline criteria for vancomycin use in patients with febrile neutropenia by describing clinical outcomes and identifying potential areas for practice improvement.
This study was a retrospective review of 275 patients. The primary outcome was to compare the number of patients meeting the criteria for vancomycin in those receiving and not receiving vancomycin. Secondary outcomes were to compare the guideline criteria in patients with and without identified gram-positive infections, determine the accuracy of the guideline criteria for vancomycin use in predicting gram-positive infections, assess discontinuation of vancomycin at 48 hours, and compare clinical outcomes between those receiving and not receiving vancomycin.
Of the identified febrile neutropenia patients, 91.3% met the criteria for empiric vancomycin use. Although 85.1% of patients tested negative for gram-positive bacteria, 89.7% of them met the criteria to receive vancomycin. Discontinuation of vancomycin within 48 hours occurred in 56.4% of patients. Clinically, those receiving vancomycin had a significantly longer median time to defervescence, length of stay, and duration of antibiotics.
Vancomycin use is common, and despite adherence to guideline concordant prescribing, those receiving vancomycin had poorer clinical outcomes. There is a need for identification of more specific risk factors for gram-positive infections, and more education on the appropriate use of vancomycin to promote proper utilization and ensure optimal patient outcomes.