2026 Southeastern Residency Conference

Evaluation of Febrile Neutropenia Prophylaxis Use in Inpatient Oncology
Olivia Jones, PharmD; Sarah Bowman, PharmD, BCOP; Samantha Lightle, PharmD
Huntsville Hospital – Huntsville, AL


Background: Febrile neutropenia is a common and potentially serious complication among patients with hematologic malignancies. The National Comprehensive Cancer Network (NCCN) provides evidence-based guidance to identify oncology patients who qualify for prophylactic antimicrobial therapy to prevent febrile neutropenia. Consistent application of these recommendations is critical for reducing infection-related morbidity and mortality. Prior evaluation at our institution has highlighted gaps in guideline adherence, particularly among high-risk populations such as patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), myelodysplastic syndromes (MDS), and multiple myeloma (MM). The purpose of this retrospective chart review is to evaluate current antimicrobial prescribing patterns and associated outcomes in these populations.


Methodology: This single-center, IRB-approved, pre–post implementation study was conducted at Huntsville Hospital to evaluate prescribing patterns of prophylactic antimicrobials and associated outcomes in patients at high risk for febrile neutropenia. The pre-intervention group included hospitalized patients with the aforementioned hematologic malignancies between January 1, 2025 and August 31, 2025. Data extracted from the electronic medical record included demographics, chemotherapy regimens, risk factors, use of prophylactic antimicrobial agents, and incidence of febrile neutropenia. Following analysis of baseline data, a disease specific decision support tool and educational initiative were developed and delivered to oncology nurse practitioners and pharmacists in early March 2026. Post-intervention data was collected from the same patient population following March 10, 2026.  The primary outcome was percentage of eligible patients who received appropriate prophylactic antimicrobials.


Results: A total of 87 patients were included in the pre-implementation group and 15 patients in the post-implementation group. Appropriate prophylactic antimicrobial use among eligible patients increased from 42.8% (3/7) to 100% (3/3) for antibacterial prophylaxis and from 50% (10/20) to 100% (3/3) for antifungal prophylaxis. Antiviral prophylaxis increased from 50.9% (26/51) to 57.1% (8/14). Median time to prophylaxis initiation decreased from 80.7 to 4.7 hours for antibacterial agents and from 17.9 to 4.7 hours for antifungal agents. Antiviral prophylaxis showed minimal change in time to initiation (19.6 vs 18.6 hours). Febrile neutropenia incidence did not differ consistently between groups. In the pre-implementation cohort, patients who received prophylaxis had lower absolute neutrophil counts and longer hospital lengths of stay compared to those who did not receive prophylaxis.


Conclusions: A pharmacist-driven educational initiative was associated with improved adherence to guideline-recommended prophylactic antimicrobial use, particularly for antibacterial and antifungal agents, and significantly reduced time to initiation. Variability in antiviral prescribing practices may explain the more modest changes observed in this group. These findings highlight the impact of pharmacist involvement and support further efforts to standardize prophylaxis use earlier in hospitalization.