Diagnosis of Bacteremia in Febrile Neutropenic Episodes in Children With Cancer

Santolaya, Marı́a Elena; Farfán, Mauricio J.; Maza, Verónica De la; Cociña, Manuela; Santelices, Felipe; Álvarez, Ana María Arias; Avilés, Carmen L; Becker, Ana; O’Ryan, Miguel; Roman, Paulina; Salgado, Carmen; Silva, Pamela; Topelberg, Santiago; Tordecilla, Juan; Varas, Mónica; Villarroel, Milena; Viviani, Tamara; Zubieta, Marcela; Torres, Juan Pablo

doi:10.1097/inf.0b013e31822a37d7

Cited by 30 publications

(30 citation statements)

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“…However, in 80% of cases, no infection can be demonstrated (6,7). The levels of circulating cytokines have been studied in patients with ALL presenting fever and neutropenia in the presence of overt infection (8,9); however, to date, no studies of patients with ALL and fever without apparent infection have been published. It is important to characterize the inflammatory profile in patients with ALL presenting febrile episodes without clinically apparent infection, as this may influence the medical management of these patients.…”

Section: Introductionmentioning

confidence: 99%

Strong inflammatory response and Th1-polarization profile in children with acute lymphoblastic leukemia without apparent infection

et al. 2016

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Children with acute lymphoblastic leukemia (ALL) often present fever. Febrile states are usually associated with infectious processes that generate an inflammatory response involving various molecules, including cytokines. However, an inflammatory response may also occur in the absence of infection. We hypothesized that the levels of inflammatory cytokines are increased in children with ALL without apparent infection. The serum levels of 13 cytokines in 99 patients with ALL and 48 non-oncological patients without apparent infection were measured using multiplex analyte profiling technology (Luminex®). The concentration of circulating pro-inflammatory cytokines associated with fever was similar between patients with ALL and fever at diagnosis and those without fever. The levels of tumor necrosis factor α, interleukin (IL)-6, IL-8, monocyte chemoattractant protein-1 (MCP-1) and IL-10 were higher in patients with ALL vs. the control group (P<0.05). Moreover, the levels of the T helper 1 (interferon‑γ and IL-12) cytokines were higher in patients with ALL vs. the control group. Transforming growth factor β was lower in patients with ALL vs. the control group (P<0.05). The levels of IL-1β, IL-2, IL-4, IL-13, and IL-17 were similar in the two groups. Our results indicate that the circulating levels of seven of the important studied cytokines are elevated in patients with newly diagnosed ALL without apparent infection, reflecting a strong and deregulated inflammatory state in this disease, with a Th1-polarization profile.

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Section: Introductionmentioning

confidence: 99%

Strong inflammatory response and Th1-polarization profile in children with acute lymphoblastic leukemia without apparent infection

et al. 2016

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“…Unfortunately, BC can identify pathogens in only 40 % of children with fever and can take >24 h to yield a report [3]. …”

Section: Discussionmentioning

confidence: 99%

“…In 40 % of children that have clinical diagnosis of sepsis and 75 % of those with high-risk FN, the microorganisms cannot be detected by currently available conventional microbiological techniques [3]. Early empirical treatment of fever in cancer patients remains the standard of care for the management of febrile neutropenia (FN).…”

Section: Introductionmentioning

confidence: 99%

Clinical relevance of molecular identification of microorganisms and detection of antimicrobial resistance genes in bloodstream infections of paediatric cancer patients

et al. 2016

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BackgroundBloodstream infections (BSIs) are the major cause of mortality in cancer patients. Molecular techniques are used for rapid diagnosis of BSI, allowing early therapy and improving survival. We aimed to establish whether real-time quantitative polymerase chain reaction (qPCR) could improve early diagnosis and therapy in paediatric cancer patients, and describe the predominant pathogens of BSI and their antimicrobial susceptibility.MethodsBlood samples were processed by the BACTEC system and microbial identification and susceptibility tests were performed by the Phoenix system. All samples were screened by multiplex 16 s rDNA qPCR. Seventeen species were evaluated using sex-specific TaqMan probes and resistance genes blaSHV, blaTEM, blaCTX, blaKPC, blaIMP, blaSPM, blaVIM, vanA, vanB and mecA were screened by SYBR Green reactions. Therapeutic efficacy was evaluated at the time of positive blood culture and at final phenotypic identification and antimicrobial susceptibility results.ResultsWe analyzed 69 episodes of BSI from 64 patients. Gram-positive bacteria were identified in 61 % of the samples, Gram-negative bacteria in 32 % and fungi in 7 %. There was 78.2 % of agreement between the phenotypic and molecular methods in final species identification. The mecA gene was detected in 81.4 % of Staphylococcus spp., and 91.6 % were concordant with the phenotypic method. Detection of vanA gene was 100 % concordant. The concordance for Gram-negative susceptibilities was 71.4 % for Enterobacteriaceae and 50 % for Pseudomonas aeruginosa. Therapy was more frequently inadequate in patients who died, and the molecular test was concordant with the phenotypic susceptibility test in 50 %.ConclusionsqPCR has potential indication for early identification of pathogens and antimicrobial resistance genes from BSI in paediatric cancer patients and may improve antimicrobial therapy.

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“…En la Tabla 2 se especifican los patógenos más frecuentes según el tipo de organismo. Dentro de los gérmenes detectados con mayor frecuencia en pacientes con neutropenia febril de alto riesgo estan S. aureus, E. faecalis, S. pneumoniae, S. pyogenes, E. coli, Klebsiella pneumoniae, Acinetobacter y P. aeruginosa 5,20,21 , esta última se ha reportado hasta en un 5% de los casos en niños. En las últimas décadas, se ha visto un cambio en la epidemiología de las infecciones en pacientes con neutropenia febril, debido a modificaciones en los tratamientos quimioterapéuticos con manejos más mieloablativos que llevan a mayor intensidad y duración de la neutropenia, aumento del tiempo de la internación y por consiguiente, incremento de las infecciones por gérmenes nosocomiales 2 .…”

Section: Neutropeniaunclassified

Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

2015

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RESUMENIntroducción: La neutropenia febril en el paciente pediátrico con enfermedad oncológica es una situación frecuente asociada a la quimioterapia que lleva a una alta morbimortalidad. Su principal etiología es la infección, ameritando un estudio oportuno y completo para identificar el origen e instaurar un tratamiento de forma rápida y dirigida, por lo cual es necesario conocer sobre esta patología y su abordaje. Objetivo: Realizar una revisión actual y completa de esta patología, abordando su epidemiología, etiología, diagnóstico clínico y tratamiento. Metodología de búsqueda: Se realizó una búsqueda en bases de datos como Cochrane Library, Medscape, Pubmed, RIMA, Ebscohost, HINARI, Dynamed, NEJM, usando palabras clave como neutropenia, fiebre, infección, riesgo, neoplasia y tratamiento. Se seleccionaron principalmente guías de práctica clínica, revisiones sistemáticas y estudios clínicos aleatorios. Discusión: Esta situación se presenta principalmente en pacientes con neoplasias hematolinfoides y la causa de la fiebre se debe en primer lugar a una infección, cuyo agente etiológico varía según la procedencia del caso, el uso de catéteres intravenosos o si hay neutropenia profunda y prolongada. El abordaje diagnostico debe ser mediante un examen físico minucioso y el uso de herramientas como hemograma, reactantes de fase aguda y policultivos. El uso de modelos pronósticos para realizar estratificación del riesgo de complicaciones permite dirigir el manejo antibiótico que se va a instaurar. Conclusión: Mediante la mejoría del conocimiento de esta enfermedad, las estrategias de diagnóstico y tratamiento han podido mejorar la sobrevida y el pronóstico de los pacientes con esta patología. MÉD UIS. 2015;28(3):353-62.Palabras clave: Fiebre. Neutropenia. Neoplasias. Pediatría. Infección. Approach to the pediatric patient with febrile neutropenia and oncologic diseaseABSTRACT Introduction: Febrile neutropenia in pediatric patients with oncological disease, is a common condition leading to high morbidity and mortality. The main cause is infection, meriting a timely and comprehensive study to identify its source and begin an early and a targeted therapy, it is necessary to know about this disease and its management. Objective: Perform a current review of this pathology by addressing its epidemiology, etiology, clinical diagnosis and treatment. Methods: Search in database like Cochrane Library, Medscape, Pubmed, RIMA, Ebscohost, HINARI, Dynamed, NEJM, using keywords like neutropenia, fever, infection, risk, neoplasia and treatment. We selected clinical practice guidelines, systematic reviews and randomized clinical trials. Discussion: It is a common situation mainly in patients with hematological malignancy and the cause of the fever is due to an infection whose etiologic agent varies according to origin of the case, use of intravenous catheters or prolonged and deep neutropenia. The diagnostic approach must be through physical examination and the use of diagnostic tools such blood count, acute phase reactants and poly...

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Diagnosis of Bacteremia in Febrile Neutropenic Episodes in Children With Cancer

Cited by 30 publications

References 30 publications

Strong inflammatory response and Th1-polarization profile in children with acute lymphoblastic leukemia without apparent infection

Strong inflammatory response and Th1-polarization profile in children with acute lymphoblastic leukemia without apparent infection

Clinical relevance of molecular identification of microorganisms and detection of antimicrobial resistance genes in bloodstream infections of paediatric cancer patients

Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

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