Pathway Background and Objectives
Cancer patients undergoing chemotherapy are at high risk of infection due to a multitude of factors including their underlying disease process, the presence of central lines, and chemotherapy induced neutropenia and immunosuppression. Infection is subsequently a major cause of morbidity and mortality in this population. Often, the first sign of a potential infection is fever, and febrile events occur in approximately 1/3rd of cancer patients with neutropenia. Early antibiotic administration has been associated with higher survival rates. In an effort to improve rapid evaluation and administration of antibiotics, standardized protocols have been shown to improve outcomes. Broad-spectrum antibiotics are routinely given to cover for gram-positive and gram-negative organisms. Due to the increased practice of prophylactic antimicrobials and the use of central lines, there has been a shift towards a dominance of gram-positive bacteremia, including methicillin resistant staphylococcus aureus (MRSA). As a result, early vancomycin treatment may reduce mortality in high risk patients. However, judicious use of these antibiotics is warranted as there has been a link between their overuse and the development of drug resistant organisms.
The objectives of this pathway are to:
- Decrease time to antibiotics
- Decrease morbidity/mortality from infection
- Improve rate of correct antibiotic coverage for neutropenic oncology patients with different risk factors
- Decrease unnecessary long-term antibiotic use and associated toxicities
- Increase rate of proper anti-fungal coverage
- Decrease unnecessary admissions for low risk patients