Overcoming challenges to reduce time to antibiotic therapy in febrile neutropenic children: insights from a Mexican center.

Julia Esther Colunga-Pedraza, Ingrid Gabriela Lopez-Reyna, Denisse Natalie Vaquera-Aparicio, Samantha Paulina Peña-Lozano, Jafet Arrieta, Lucía Elizabeth Hernández-Torres, Perla Rocío Colunga-Pedraza, Mónica Regalado, Yajaira Valentine Jiménez-Antolinez, Fernando García-Rodríguez, Oscar González-Llano
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Abstract

Background: Providing quality supportive therapy for children with cancer is essential to reduce the high mortality rates in low- and middle-income countries. Febrile neutropenia is the most common life-threatening complication of cancer in children. The objective of this study was to evaluate the long-term effectiveness of the 'Golden Hour' intervention in reducing the time to administer antibiotics and its impact on clinical outcomes in a Mexican hospital.

Methods: A comparative study of children with febrile neutropenia who attended the emergency department at the Hospital Universitario "Dr. José Eleuterio González" was performed between January 2017 and December 2022. In May 2019, this center joined the collaborative 'Mexico in Alliance with St. Jude' project. An adapted improvement program was developed based on the implementation of an algorithm comprising institutional guidance, supplies kit, standardization of sample processing, training of healthcare providers, and patient education. The time to antibiotic administration was compared with clinical outcomes between the historical control and post-intervention groups.

Results: A total of 291 patients were included, 122 in the pre-intervention period and 169 in the intervention period. Only 5.7 % of the pre-intervention group received the first dose of antibiotics within 60 min of presenting to the emergency department compared to 84.6 % in the intervention group (p-value <0.000). The median times to antibiotic administration in the pre-intervention and post-intervention periods were 269.4 and 50.54 min, respectively (p-value <0.000). Clinical deterioration and admission to the pediatric intensive care unit decreased significantly from 6.6 % to 2.3 % (p-value = 0.03).

Conclusions: Sustainability of the quality improvement project 'Golden Hour' in low- to mid-income countries demonstrated high effectiveness in reducing time to antibiotic administration among children with febrile neutropenia and improved clinical outcomes over three years of implementation.

克服困难,缩短发热性中性粒细胞减少儿童接受抗生素治疗的时间:来自墨西哥中心的启示。
背景:在中低收入国家,为癌症患儿提供高质量的支持疗法对于降低高死亡率至关重要。发热性中性粒细胞减少症是儿童癌症最常见的危及生命的并发症。本研究旨在评估 "黄金一小时 "干预措施在减少抗生素用药时间方面的长期有效性,以及它对墨西哥一家医院临床结果的影响:2017年1月至2022年12月期间,对在 "何塞-埃莱乌特里奥-冈萨雷斯博士 "大学医院急诊科就诊的发热性中性粒细胞减少症患儿进行了比较研究。2019 年 5 月,该中心加入了 "墨西哥与圣裘德联盟 "合作项目。在实施包括机构指导、耗材包、样本处理标准化、医疗服务提供者培训和患者教育在内的算法的基础上,制定了一项经过调整的改进计划。对历史对照组和干预后组的抗生素用药时间和临床结果进行了比较:结果:共纳入 291 名患者,其中 122 名在干预前,169 名在干预后。干预前组中只有 5.7% 的患者在急诊科就诊后 60 分钟内接受了第一剂抗生素治疗,而干预后组的这一比例为 84.6%(P 值 结论:干预后组患者在急诊科就诊后 60 分钟内接受了第一剂抗生素治疗,而干预前组患者在急诊科就诊后 60 分钟内接受了第一剂抗生素治疗:在中低收入国家持续开展的 "黄金一小时 "质量改进项目在缩短发热性中性粒细胞减少症患儿的抗生素用药时间方面具有很高的有效性,并在实施三年后改善了临床效果。
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