Impact of time-to-antibiotics on hospital mortality in patients with hematological malignancies and febrile neutropenia: a single center propensity score matching analysis.

We performed a retrospective study in patients with febrile neutropenia between 2005 and 2020 to assess the impact of time-to-antibiotics (TTA) on mortality. We included 1089 patients (58% males) aged 58 [46-67] years with hematological malignancies (62% acute leukemias, 20% lymphomas). TTA was 132 [68-271] minutes and hospital mortality was 9.1%. Hourly TTA was not associated with mortality in multivariate logistic regression. Hospital mortality was lower in patients with TTA ≤4 h (8.0% versus 11.9%, p = 0.04) and after propensity score matching based on comorbidities, vital signs and biological parameters at the time of fever, TTA ≤4 h remained associated with decreased mortality (odds ratio 0.55, 95% CI 0.31-0.96, p = 0.038). These findings were not confirmed in subgroups of patients with sepsis or bacteremia. Our study confirmed that TTA >4 h was associated with increased mortality but does not support recommendations of TTA ≤1 h in febrile neutropenia.