| Objective: Retrospective analysis of the use of Granulocyte Colony-Stimulating Factors and anti-infective drugs in patients with Febrile Neutropenia after chemotherapy in a provincial cancer hospital,evaluating the hospital’s compliance with clinical guidelines for drugs treatment of this type of patients,to standardize the clinical rational drug use of patients with FN related to tumor chemotherapy,and provide references for further improving the quality of tumor treatment.Methods: Cases that met the selection criteria for chemotherapy-related FN from October 1,2018 to January 31,2020 were screened,and a database was established of clinical datas such as gender,age,disease,chemotherapy regimen,and FN drug treatment.Analyzed the compliance of the guidelines for the use of PEG-rh G-CSF,rh G-CSF,and anti-infective drugs(Antibacterial drugs,Antifungal drugs)from the aspects of medication indications,drug selection,medication timing,administration route,usage and dosage,and treatment duration,and counted statistics and analysis of the reasons for non-compliance.We used the China’s "Guidelines for the Standardized Management of Tumor Radiotherapy and Chemotherapy-related Neutropenia"(2017 Edition),the"Guidelines for the Clinical Application of Antibacterials in Patients with Neutrophil Deficiency and Fever in China"(2016 Edition)and the US "NCCN Guidelines Version 2.2020 Myeloid Growth" Factors "," Prevention and Treatment of Cancer-Related Infections,Version 1.2020,NCCN Clinical Practice Guidelines in Oncology "as the basis,in areas where there was insufficient evidence,it was replaced by expert consensus" Experts in the diagnosis and treatment of neutropenia caused by tumor chemotherapy "Consensus(2019 edition).All data processing used SPSS23.0 software,classification data was described by row ratio,rate and other statistics;quantitative data was described by x ± s;comparison between groups used independent sample t test or chi-square test according to data type P <0.05 was considered statistically significant.Results: This experiment screened out 119 cases of FN hospitalization related to tumor chemotherapy in the hospital.All cases used G-CSFs for FN treatment or prevention,the rh G-CSF group had the highest compliance rate(73.85%),while the PEG-rh G-CSF group and rh G-CSF+PEG-rh G-CSF group had poorer compliance rates.The compliance rate of rh G-CSF group was significantly different from that of rh G-CSF+PEG-rh G-CSF group and PEG-rh G-CSF group(P=0.000,P=0.000);PEG-rh G-CSF group and rh G-CSF+PEG-rh G-CSF.The compliance rate of rh G-CSF group had no statistical difference(P=0.081).In terms of prevention,64.71% of cases could make correct prevention decisions based on whether there were indications to prevent the use of G-CSFs,among them,the compliance of the FN high-risk group and the risk of FN* prevention drugs were 83.33% and 66.64%,respectively,and there was no statistical difference between the two groups in the compliance of preventive drugs(P=0.165).In terms of treatment,the compliance rate of G-CSFs drugs during treatment is 52.10%.The main problems of non-compliance during the prevention process were the premature intervention(preventive administration during chemotherapy,or the administration is not more than 24 h from the end of chemotherapy),and rh G-CSF preventive medication was not enough.The problems of non-compliance of G-CSFs in treatment were that PEG-rh G-CSF was used for the treatment of FN after diagnosising(33.85%),followed by no indications for the addition of PEG-rh G-CSF or rh G-CSF(6.25% VS 15.38%).115 of 119 cases were treated with anti-infective drugs to prevent and treat chemotherapy-related FN.In terms of prevention,79.83% of the cases made preventive medication decisions in accordance with the guidelines according to the infection risk classification,among them,the compliance rate of indications for the prevention of high-risk cases was 11.11%,and the cases of low-risk infections were not prevented by anti-infective drugs following the guidelines.The compliance rate was 100%.The compliance rate of the indications between the two groups was statistically different(P=0.000).However,the compliance rate of preventive medication guidelines was 0%,the reasons for the low compliance rate were did not use of levofloxacin or ciprofloxacin oral drugs in the prevention group,and the combination of antibacterial drugs in the absence of other infection symptoms,rather than the single drug prevention recommended by the guide;There was no problem of non-compliance in the use of Antifungal drugs for prevention.In terms of treatment,the compliance rate of therapeutic drugs is 57.00%,88.46% of the reasons for non-compliance with therapeutic anti-infective drugs occurred in the treatment of bacterial infections,mainly due to non-compliance in initial empirical treatment selection(36.54%),no indication for combining use of antibacterial drugs(17.31%),and no medication was given within 1 hour after diagnosis of FN(15.38%)and the treatment period was too long(3.85%),or too short(7.69%).Three cases had no initial empirical medication after diagnosising of FN(7.69%).The main problem of antifungal therapy was that the timing of intervention was too early(9.62%).Taken together,there is a statistical difference between the compliance rate of the medication guidelines in the prevention group and the treatment group(P=0.000),and the non-compliance rate in the bacterial infection treatment group is higher than that in the fungal infection treatment group,and the results are statistically different(P=0.000)In this study,the blood culture inspection rate was 76.52%,the blood culture qualification rate was 88.64%,and the detection rate was 9.09%.The most common site of infections was lung infection,followed by bloodstream infection,skin and mucous membrane infection,intestinal infection,and urinary tract infection.The most detected were Pseudomonas aeruginosa and Candida,3cases each,and the remaining Staphylococcus aureus,Escherichia coli,and ESBL-producing Escherichia coli were each 1 case,three cases of unidentified microorganisms.Among them,41.67% were Gram-negative bacteria,8.33%were Gram-positive bacteria,and 25.00% were Candida,and 25.00% of unidentified microorganisms.The compliance rate of G-CSFs combined with anti-infective drugs in all cases was low(16.81%),G-CSFs drug compliance rate was 50.42% and anti-infective drug compliance rate was 54.78%.According to the cases of prevention using G-CSFs,the prevention and compliance of FN high-risk group was better than that of FN medium-risk additional patients(83.33% VS 66.67%),53 of 57 preventive medication cases followed 24 h to 96 h after chemotherapy administration(92.98%).In terms of the use of anti-infective drugs,the compliance rates of antibacterial drugs and antifungal drugs in prevention and treatment were 49.57% and 66.67%,respectively.The compliance of the drugs within 1 hour after diagnosis of FN was better(92.17%),97.73% blood culture compliance guidelines "Double blood cultures,at least two separated blood collection points",3 of 10 CVC blood or tube tips were sent for examination.In terms of body temperature detection methods,according to relevant foreign research,mouth temperature is closer to the core temperature of the human body and is a more accurate method of body temperature measurement than armpit temperature.Therefore,we should strengthen publicity and education to measure oral temperature and improve the accuracy of FN diagnosis.Conclusion: The compliance rate of G-CSFs drugs and anti-infective drugs in FN patients with tumor chemotherapy in the hospital is not ideal.G-CSFs have higher compliance with the indications for preventive medication,but have poorer compliance with the timing of medication,drug selection,and combined medication indications.There are also many problems with the compliance of anti-infective drugs.The main problems include low use of prophylactic antifungal drugs,poor compliance with the choice of drugs for prevention and initial empirical treatment,no indication for combination medication,and too late initial empirical drug intervention(> 1h).The blood cultures compliance were good,and most of them were submitted for testing according to the guidelines,but the positive rate of culture is low,mainly Gram-negative bacteria and fungi,which is similar with other domestic and foreign literature reports.The results of this study suggests that the study and promotion of cancer chemotherapy-related FN patients’ drug treatment guidelines must be strengthened,the compliance of G-CSFs drugs and anti-infective drugs needs to be improved,and the temperature detection methods need to be changed. |
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