Klastersky et al reported factors predictive of successful outpatient oral antibiotic therapy for a cancer patient with febrile neutropenia. The authors are from Institut Jules Bordet in Brussels.
Patient selection: cancer patient with febrile neutropenia
Predictors for successful discharge with outpatient oral antibiotic therapy from univariate analysis:
(1) age < 40 years (OR 2.4)
(2) Karnofsky Performance Scale >= 80 (OR 2.7)
(3) high physiological reserve (OR 3.3)
(4) absence of symptoms of febrile neutropenia (OR 2.7)
(5) outpatient status at fever onset (OR 3.5)
(6) adjuvant or neoadjuvant therapy (OR 1.9)
(7) Talcott IV (OR 2.6)
where:
• Talcott groups range from I to IV, with IV associated with the best prognosis.
• High physiological reserve would be at the opposite end of the spectrum to frailty.
In multivariate analysis the 2 independent factors were:
(1) outpatient status at fever onset (OR 3.4)
(2) high physiological reserve (OR 5.7)
The number of patients meeting the criteria are low, but outpatient therapy can result in significant cost savings.
