Background: Neutropenic fever is a common complication in patients with myeloid neoplasms. While patients typically receive intravenous (IV) antibiotics until neutrophil recovery, a growing body of literature shows the safety of de-escalation prior to this endpoint. The impact of this early de-escalation on health care utilization remains unclear. Methods: We conducted a retrospective analysis of hospitalized myeloid neoplasm patients at our institution with neutropenic fever, assessing the impact of IV antibiotic de-escalation prior to neutrophil recovery on length of stay (LOS). Manual chart review was performed on this cohort to assess clinical outcomes. Multivariable linear regression was performed, adjusting for age, diagnosis, Charlson Comorbidity Index, intensity of chemotherapy received, positive bacterial culture result, last hospital day with fever, and last hospital day with neutropenia. Results: Patient characteristics are shown in Table 1. Most de-escalation patients (67.7%) were discharged within 72 hours of stopping IV antibiotics. After adjusting for the above variables, early antibiotic de-escalation was associated with lower LOS of 2.7 days (95% confidence interval [CI] 2.0–3.3 days, p< 0.001), an effect that appeared most pronounced in the high very risk chemotherapy group (3.6 day reduction, 95% CI 2.5–4.6 days, p = 0.007). Review of clinical outcomes of de-escalation patients showed 5 potentially preventable recurrent or worsening fever or infectious incidents. Conclusions: Early de-escalation of IV antibiotics was associated with a statistically and clinically significant reduction in LOS, with very few clinical complications. To our knowledge, our study is the first to demonstrate a significant reduction in length of stay, an important hospital quality metric. Further prospective data is needed to confirm this relationship.

¹ Median (IQR); n (%)

² Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test

³ Categorized by degree of immunosuppression

⁴ Defined as positive microbiologic culture at any time during hospitalization