Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial

Santolaya, Marı́a Elena; Alvarez, Alina Concepción; Acuña, Mirta; Avilés, Carmen L; Salgado, Carmen; Tordecilla, Juan; Varas, Mónica; Venegas, Marcela; Villarroel, Milena; Zubieta, Marcela; Toso, Alberto; Bataszew, A.; Farfán, Mauricio J.; Maza, Verónica De la; Vergara, Alejandra; Valenzuela, Rodrigo; Torres, Juan Pablo

doi:10.1016/j.cmi.2016.11.001

Cited by 58 publications

(25 citation statements)

References 31 publications

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“…It is very likely that patients with fever lasting 24-36 h do not need antimicrobial treatment. Santolaya et al have proposed to withhold antimicrobial treatment in children with cancer, fever, and neutropenia if a respiratory infection is present until a result of a polymerase chain reaction microarray for 17 respiratory viruses confirm a viral infection 21 ; in our study, most of the patients had FUO. Some authors have ruled out the importance of the administration time for the first dose of antimicrobial in children with FN 22 .…”

Section: Discussionmentioning

confidence: 49%

Piperacillin/Tazobactam in Continuous Infusion versus Intermittent Infusion in Children with Febrile Neutropenia

Solórzano-Santos

Quezada-Herrera

Fuentes-Pacheco

et al. 2019

RIC

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Background: Febrile neutropenia (FN) is a common complication in children who receive chemotherapy for cancer. Objective: The objective of this study was to evaluate the clinical efficacy of the continuous versus intermittent infusion of piperacillin/ tazobactam (TZP) in febrile neutropenic pediatric patients. Methods: This is a non-blinded randomized controlled clinical trial. Eligible group consisted of hemato-oncological patients with FN who were candidates to receive TZP. Patients were randomized to one of two groups: Group 1 received antibiotic treatment through intravenous intermittent infusion of TZP 300 mg/kg/day based on piperacillin, divided into four doses, not exceeding 16 g/day; Group 2 received an initial TZP loading dose of 75 mg/kg infusion over 30 min, and then a continuous infusion of TZP 300 mg/kg/day through central line with pump over 24 h. Results: There were 176 episodes that could be assessed, 100 in Group 1 and 76 in Group 2. There was no statistically significant difference in treatment failure in the experimental group (continuous infusion) compared with the intermittent group, 21% versus 13% (p = 0.15). The increase in the absolute risk reduction was 0.08% (95% confidence interval 0.12-0.30), and the number needed to treat was 12.4. One patient in each group died. Conclusions: There were no differences in fever resolution, clinical cure rate, or mortality when comparing the continuous with the intermittent TZP infusion.

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Section: Discussionmentioning

confidence: 49%

Piperacillin/Tazobactam in Continuous Infusion versus Intermittent Infusion in Children with Febrile Neutropenia

Solórzano-Santos

Quezada-Herrera

Fuentes-Pacheco

et al. 2019

RIC

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“…The misuse of antibiotics in cases of viral respiratory infections is a common problem, and a rapid result for detecting a viral pathogen may prevent the unnecessary use of antibiotics. The rapid diagnosis of respiratory infections also can shorten times in the emergency room, decrease length of stay, or prevent hospitalization and allow improved patient cohorting to prevent nosocomial infections (3,(5)(6)(7)(8)(9).…”

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confidence: 99%

Multicenter Evaluation of the QIAstat-Dx Respiratory Panel for Detection of Viruses and Bacteria in Nasopharyngeal Swab Specimens

et al. 2020

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The QIAstat-Dx Respiratory Panel (QIAstat-Dx RP) is a multiplex in vitro diagnostic test for the qualitative detection of 20 pathogens directly from nasopharyngeal swab (NPS) specimens. The assay is performed using a simple sample-toanswer platform with results available in approximately 69 min. The pathogens identified are adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus A and B, influenza A, influenza A H1, influenza A H3, influenza A H1N1/2009, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, rhinovirus/enterovirus, respiratory syncytial virus A and B, Bordetella pertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae. This multicenter evaluation provides data obtained from 1,994 prospectively collected and 310 retrospectively collected (archived) NPS specimens with performance compared to that of the BioFire FilmArray Respiratory Panel, version 1.7. The overall percent agreement between QIAstat-Dx RP and the comparator testing was 99.5%. In the prospective cohort, the QIAstat-Dx RP demonstrated a positive percent agreement of 94.0% or greater for the detection of all but four analytes: coronaviruses 229E, NL63, and OC43 and rhinovirus/enterovirus. The test also demonstrated a negative percent agreement of Ն97.9% for all analytes. The QIAstat-Dx RP is a robust and accurate assay for rapid, comprehensive testing for respiratory pathogens.

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“…Studies investigating outpatient management of pediatric FN have suggested that it is as safe and effective as traditional inpatient therapy, more cost effective, and preferred by patients, parents, and providers, with improvement in quality of life measures . Furthermore, outpatient management greatly reduces the risk of hospital‐acquired infections.…”

Section: Introductionmentioning

confidence: 99%

“…3 Despite the high incidence of chemotherapy-induced FN, only a minority of episodes are associated with a serious bacterial infection. [4][5][6][7] Recent investigations have focused on differentiating those patients who will likely develop significant illness from those who will likely have a relatively benign course. 1,5,[7][8][9][10] In adult oncology, there has been substantial research into risk stratification of patients with FN, leading to well-established guidelines for modifications to traditional management.…”

Section: Introductionmentioning

confidence: 99%

Management of chemotherapy‐induced febrile neutropenia in pediatric oncology patients: A North American survey of pediatric hematology/oncology and pediatric infectious disease physicians

Maxwell

Egan-Sherry

Gill

et al. 2017

Pediatric Blood & Cancer

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Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial

Abstract: The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population.

Cited by 58 publications

References 31 publications

Piperacillin/Tazobactam in Continuous Infusion versus Intermittent Infusion in Children with Febrile Neutropenia

Piperacillin/Tazobactam in Continuous Infusion versus Intermittent Infusion in Children with Febrile Neutropenia

Multicenter Evaluation of the QIAstat-Dx Respiratory Panel for Detection of Viruses and Bacteria in Nasopharyngeal Swab Specimens

Management of chemotherapy‐induced febrile neutropenia in pediatric oncology patients: A North American survey of pediatric hematology/oncology and pediatric infectious disease physicians

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