Abstract

Objective: This study aimed to evaluate the timing of antibiotic administration in patients with febrile neutropenia (FN) at a tertiary care hospital in Saudi Arabia and to assess its impact on clinical outcomes.
Methods: A retrospective cohort study was conducted from January 2023 to May 2025, including 149 adult oncology patients presenting to the emergency department with FN. Data on patient demographics, time from ED arrival to first antibiotic dose, and outcomes including mortality, ICU admission, and length of stay were collected electronically. Patients were categorized into those receiving antibiotics within 60 minutes or later.
Results: The mean age was 47.26±15.27 years, and 56.4% were female. Only 31.5% (n=47) of patients received antibiotics within the 60-minute benchmark, while 68.5% (n=102) experienced delays, with a mean interval of antibiotic administration after ED admission of 114.38±101.59 minutes. The overall mortality rate was 8.1%. No statistically significant associations were found between antibiotic timing and mortality (p-value=0.611), intensive care unit (ICU) admission (p-value=0.682), or hospital length of stay (LOS) (p=0.959).
Conclusion: A significant delay in antibiotic administration for FN was prevalent in the current study setting. However, in this cohort, the delay was not significantly associated with worse clinical outcomes. The high rate of non-compliance with the guideline-recommended timeframe underscores a critical need for quality improvement initiatives to optimize the timeliness of care, though its definitive impact on mortality in this population requires further investigation.

Key words: Febrile neutropenia, antibiotic timing, oncological emergency, outcomes, Saudi Arabia.