One-Hour Antibiotic Rule Not Supported in Post-HSCT Neutropenic Fever
This single-center cohort tests whether the 1-hour empiric antibiotic target borrowed from septic shock data changes outcomes in antibiotic-naïve hematopoietic stem cell transplant recipients, and finds no detectable association within a narrow timing range.
📅 Journal publication: Oct 28, 2026·Last updated: Oct 28, 2026
Does the one-hour rule for antibiotics matter in stem cell transplants?
The study questions the need for empiric antibiotics within one hour in hematopoietic stem cell transplant recipients with neutropenic fever. Time-to-antibiotics (TTA) did not affect clinical deterioration or mortality, with median TTA of 1.2 hours. Findings suggest that strict adherence to the one-hour TTA rule may not be necessary for this population. This challenges current guidelines. One-hour TTA may not impact outcomes in antibiotic-naïve HSCT recipients with neutropenic fever.
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Authors:Windham SL, Guidry CA, Sung AD, Kollef MH, Simpson SQ
Citation:Windham SL, Guidry CA, Sung AD, et al. Association between time-to-antibiotics and clinical outcomes in neutropenic fever after hematopoietic stem cell transplant. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2026;34(11). doi:10.1007/s00520-026-11141-8