Diagnosis and treatment of febrile neutropenia in pediatric cancer patients Consensus of the Sociedad Latinoamericana de Infectología Pediátrica This document is a consensus guideline on the "Diagnosis and treatment of febrile neutropenia in children with cancer" developed by the Committee for Infectious Diseases in Immunocompromised Children of the Sociedad Latinoamericana de Infectología Pediátrica. This guideline discusses the management of febrile neutropenia focused on Latin American children with cancer. It is based on a thorough review of the literature, with particular attention to experiences reported by centers within the continent in order to provide recommendations applicable to the region. The manuscript includes a description of the regional epidemiology of cancer and infections in children, recommendations for clinical and laboratory studies required for patient management, description of a classifi cation method to identify patients at different risk for invasive bacterial infections, outpatient and inpatient general care strategies and differential treatment strategies adjusted to local epidemiological realities, different algorithms for patient follow-up according to clinical course, a discussion of the rationale for prophylaxis strategies in specifi c situations including general guidelines for antifungal treatment. The Guidelines intend to provide practical, evidence-based recommendations in order to promote the best possible management for children with cancer, fever and neutropenia, throughout oncology centers of Latin America.
IntrPatients with haematological malignancies admitted to ICU have high mortality. Reticence of intensive care providers to admit and treat these patients is well described in literature. ObjectivesTo evaluate differences between survivors and nonsurvivors and provide possible independent risk factors for ICU mortality. MethodsSingle centre observational retrospective study in a 14-bed Intensive Care Unit of a University Hospital. All haematological patients admitted between January-2009 and December-2014 were enrolled. Data acquired included: demographics characteristics, haematological diagnosis, reason of ICU admission, severity-of-illness scores (APACHE and SOFA) and intensive care therapy (mechanical ventilation (VM), extrarenal therapy depuration (ETD) and vasopressor support (VS)). ResultsWe included 38 patients in the study,15(39,47%) were survivors and 23(60,52%) were non-survivors. Median age of 50,47 ± 13,98 vs 59,78 ± 14,73 (p > 0,05) and predominance of males in both groups (60% vs 73,9%, p > 0,05), respectively. In both groups non-Hodgkin lymphoma was the most frequent haematological malignancy, 53% and 30,4 %, survivors and non-survivors respectively and acute respiratory failure was the most frequent reason for ICU admission(66% and 39,1%, respectively). Intergroup comparisons revealed statistically significant differences in APACHE (19,73 ± 8,05 vs 26,48 ± 8,74, p < 0,05) and SOFA (9 ± 3,4 vs 11,83 ± 3,23, p < 0.05). During the first 24h of ICU admission, 60% of the survivors patients had 2 or more organ failures, and 73,9% in non-survivors group. During evolution in ICU, survivors patients required VM and VS in 80% and 66,7%, respectively. None of them needed EDT. Non-survivors required VM and VS in 91% and 95,7% respectively, and 17,4% needed EDT. There were no statistically significant differences in ICU support therapies between survivors and non-survivors. No independent risk factors for mortality were found by logistic regression analysis. ConclusionsMortality in patients with haematological malignancies remains high. There were significant differences in severityof-illness scores during the first twenty-four hours of ICU admission between survivors and non-survivors. No significant differences in intensive care therapy were found between groups during ICU hospitalization.
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