PURPOSE Multiple interventions have been developed aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia (FN) following chemotherapy for cancer. We evaluated their effect to reduce TTA and their impact on important clinical outcomes in a systematic review. METHODS The search covered seven databases. Biases and quality of studies were assessed with the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Interventions could be implemented in any setting and performed by any person included in the FN management. Absolute change of TTA was the primary outcome. Registration: PROSPERO (CRD42018092948). RESULTS Six thousand two hundred ninety-six titles and abstracts were screened, 177 studies were retrieved and 30 studies were included. Risk of bias was moderate to serious in 28 studies and low in two studies. All but one study reported a reduction of TTA after the intervention. Various types of interventions were implemented; they most commonly aimed at professionals. Most of the studies made more than one single intervention. CONCLUSION This review may help centers to identify their specific sources of delay and barriers to change and to define what intervention may be the best to apply. This review supports the assertion that TTA can be considered a measure of quality of care, emphasizes the importance of education and training, and describes the very different interventions which have effectively reduced TTA.

中文翻译：

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一项旨在减少癌症化疗（FN）期间发烧和中性粒细胞减少症患者使用抗生素（TTA）时间的干预措施，系统评价。

目的已开发出多种干预措施，旨在减少癌症化疗后发烧和中性粒细胞减少症（FN）患者使用抗生素（TTA）的时间。我们在系统评价中评估了它们降低TTA的作用及其对重要临床结果的影响。方法搜索覆盖了七个数据库。偏倚和研究质量通过非随机干预研究（ROBINS-I）工具中的偏倚风险进行评估。干预措施可以在任何情况下实施，并且可以由FN管理部门中包括的任何人执行。TTA的绝对改变是主要结局。注册：PROSPERO（CRD42018092948）。结果筛选了696个标题和摘要，检索了177个研究，包括30个研究。在28项研究中，偏倚风险为中度至严重，而在两项研究中为偏低。除一项研究外，所有研究均报告了干预后TTA降低。实施了各种干预措施；他们最常针对专业人士。大多数研究进行了不止一种干预。结论这项审查可以帮助中心确定其延迟的具体来源和改变的障碍，并确定哪种干预措施是最佳的。这项审查支持这样的主张，即可以将TTA视为衡量护理质量的一种手段，强调教育和培训的重要性，并描述了有效降低TTA的截然不同的干预措施。大多数研究进行了不止一种干预。结论这项审查可以帮助中心确定延迟的具体来源和改变的障碍，并确定哪种干预措施是最佳的。这项评论支持这样的主张，即可以将TTA视为衡量护理质量的一种指标，强调教育和培训的重要性，并描述了有效降低TTA的截然不同的干预措施。大多数研究进行了不止一种干预。结论这项审查可以帮助中心确定其延迟的具体来源和变化的障碍，并确定哪种干预措施是最佳的。这项审查支持这样的主张，即可以将TTA视为衡量护理质量的一种手段，强调教育和培训的重要性，并描述了有效降低TTA的截然不同的干预措施。