Outcomes in Stable Paediatric Patients With Cancer With Fever and Neutropenia According to Time to Antibiotic Administration: A Prospective Observational Study

ABSTRACT Aim To evaluate whether an increase in the time to antibiotics (TTA) administration in the paediatric emergency department worsens the clinical outcomes of well‐appearing paediatric cancer patients with febrile neutropenia (FN). Methods We performed a subanalysis of a prospective, observational study conducted in two hospitals between November 2019 and October 2021. Multivariate analysis was performed to identify independent risk factors for poor outcomes, defined as admission to the paediatric intensive care unit, sepsis or septic shock, acute organ dysfunction, long‐term sequelae, or death. Results We included 192 episodes in 163 patients. A total of 110 episodes (57.3%) had a TTA ≤ 60 min (short TTA) and 82 (42.7%) had a TTA > 60 min (long TTA). Baseline characteristics were similar in both groups, except for previous FN episodes, which were more frequent in the short TTA group (64.5% vs. 8.5%, p < 0.001). Twelve episodes (6.3%) resulted in a poor outcome, although no deaths were reported. Poor outcomes were more common in patients with higher maximum temperature (odds ratio [OR]: 2.7; 95% CI: 1.1–6.6), and elevated CRP (OR: 1.01; 95% CI 1.003–1.02). In the multivariate analysis, no variable—including TTA—was identified as an independent risk factor for poor outcome. Conclusions Delayed antibiotic administration in clinically stable paediatric FN patients did not worsen outcomes, supporting the potential feasibility of a ‘wait‐and‐observe focus’ approach.