Comparison between extended and standard infusion in patients with chemotherapy-induced febrile neutropenia: A systematic review, meta-analysis and survival analysis.

Abstract

e24094 Background: Febrile neutropenia is a serious and potentially life-threatening complication that often arises during chemotherapy treatment for cancer. The standard treatment protocol for febrile neutropenia involves the prompt administration of intravenous broad-spectrum antibiotics, which can be administered in bolus standard dose (SI), or continuous extended infusion (EI). This meta-analysis aims to assess the differential outcomes in patients administered either EI or SI. Methods: A comprehensive literature search was conducted across 4 databases to identify original studies evaluating the use of EI and SI antibiotics in patients with febrile neutropenia. Data analysis was conducted using R employing a random-effects model. Further, a Kaplan-Meier (KM) survival analysis was conducted to assess the time of defervescence. Results: A total of 8 studies comprising 1,008 patients were included for quantitative analysis. Survival analysis using a KM plot revealed no significant differences between the use of EI and SI (p = 0.22). On evaluating outcomes on specific days, a significantly higher number of patients achieved defervescence by 24 hours (OR: 1.55 [1.08, 2.21]), while the odds of recovery on days 2-7 were slightly higher on the use of EI, although statistically insignificant. Clinical success was insignificantly higher in the EI arm (OR: 1.13 [0.53, 2.42]). Correspondingly, a slightly higher number of patients observed treatment failure on the use of SI (OR: 0.76 [0.33, 1.72]), necessitating escalation of antibiotics, which was higher in the SI arm (OR: 0.81 [0.47, 1.39]). Clinical suspicion of infection following therapy was higher in the SI arm (OR: 0.92 [0.65, 1.3]), implying a rise in temperature or signs of reinfection, however microbiologically confirmed infections were insignificantly higher in the EI arm (OR: 1.06 [0.59, 1.87]). Quantifying long-term outcomes, the length of hospital stay was lesser in the SI arm (OR: -2.45 [-6.03, 1.12]). All-cause 30-day mortality was slightly higher in the EI arm, although statistically insignificant (OR: 1.06 [0.59, 1.87]). Conclusions: Both EI and SI were similar in their efficacy, patient outcomes and long-term outcomes. EI resulted in a slightly faster response within 24 hours, while SI was associated with faster complete recovery and discharge. Trends signify a slightly higher risk of 30-day mortality on the use of EI, which may be due to the higher dose of antibiotics further leading to systemic complications. Hence, our results suggest that there are no factors to favor the use of EI and that SI should be employed as the standard mode of delivery of intravenous antibiotics in patients with febrile neutropenia. Further randomized trials are needed to verify these findings and allow for the employment of these findings into guidelines for the management of febrile neutropenia.