# Reducing the Time-to-Antibiotic by Adapting a Standard of Procedure for the Treatment of Pediatric Cancer Patients Presenting with Febrile Neutropenia—A Comparative Analysis of Two Patient Cohorts

## TL;DR

This study shows that changing hospital procedures can significantly reduce the time it takes to give antibiotics to children with cancer who have febrile neutropenia, improving care quality without increasing complications.

## Contribution

The study demonstrates that simple procedural changes can significantly reduce time-to-antibiotic in pediatric cancer patients with febrile neutropenia.

## Key findings

- After SOP changes, 32.9% of episodes met the 30-minute antibiotic target, up from 5.9% previously.
- Median time-to-antibiotic decreased from 93 minutes to 44 minutes post-SOP implementation.
- No significant increase in adverse events was observed despite the improved treatment speed.

## Abstract

Children undergoing cancer treatment are at high risk of developing febrile neutropenia, a potentially life-threatening condition. Rapid administration of antibiotics is essential, and the time-to-antibiotic (TTA) is considered a key measure of care quality. In this retrospective study, we evaluated whether simple modifications to a standard operating procedure (SOP), such as defining a clear 30 min target and ensuring immediate access to antibiotics, could improve treatment delivery. After SOP implementation, the TTA was reduced by more than half, and a significantly higher proportion of patients received antibiotics within the target time window. While complication rates remained unchanged in this cohort, shorter treatment times represent an important improvement in quality of care. These findings underline the importance of operational measures in optimizing care quality and provide a feasible strategy to improve the management of febrile neutropenia.

Background: Febrile neutropenia (FN) is a common and potentially life-threatening complication in pediatric oncology. Rapid initiation of empiric antibiotics is critical to improving prognosis. This study evaluated the impact of simple changes to a standard operating procedure (SOP) for FN treatment on the time-to-antibiotic (TTA) in pediatric cancer patients, as well as potential clinical effects. Methods: In this retrospective, single-center, cohort study, children with cancer presenting with FN at the emergency room (pedER) or oncology outpatient department (OD) were included over two one-year periods—before and after SOP adaption. The revised SOP defined a target TTA of ≤30 min. The primary endpoint was to compare median TTA and the proportion of FN episodes meeting target TTA. Secondary endpoints comprised adverse events (AEs) (e.g., ICU admission, need for respiratory or circulatory support, sepsis criteria). Results: After SOP adaption, 32.9% of episodes met target TTA, up from 5.9% before. Median TTA was significantly reduced (44 min vs. 93 min). The improvement persisted during the study period. AE rates showed no significant change. Conclusions: Simple procedural adjustments may significantly improve quality indicators of care, e.g., reducing TTA in pediatric FN patients. These adjustments may be transferable to other pediatric oncology settings.