Empfehlungen zur Diagnostik und Therapie bei krebskranken Kindern mit Fieber und Neutropenie – Vergleich zweier aktueller Leitlinien

Abstract

Immunocompromised children and adolescents receiving treatment for cancer have a considerably increased risk for infection. Neutropenia is the most important single risk factor for infectious complications, and fever in neutropenia is considered as an emergency. Whereas guidelines for the management of fever in neutropenic adults have been established for decades, specific pediatric guidelines have not been developed until recently. As children differ in many aspects from adults such as in the underlying malignancy or in the availability and dosing of antimicrobial compounds, guidelines for pediatric patients are important. This article reviews similarities and differences between the recently published German interdisciplinary guideline of the German Societies of Pediatric Infectious Diseases and Pediatric Oncology and Hematology and a guideline developed by a panel of international experts for the management of fever in neutropenia in children and adolescents.

Management of children with fever and neutropenia: results of a survey in 51 pediatric cancer centers in Germany, Austria, and Switzerland

“…However, it is important to note that the international guidelines on FN in the pediatric setting have been available starting in 2012 (updated in 2017 [ 11 ]. The German guideline differs only in a few issues from these international guidelines [ 12 ], including that the German guideline is not applicable to patients, who need intensive care due to severe sepsis, it does not recommend a priori risk stratification in high- and low-risk groups, and it argues against the use of meropenem (a carbapenem) as first-line treatment in stable patients. One important purpose of this survey was to identify potential targets for antibiotic stewardship (ABS).…”

Antimicrobial use in pediatric oncology and hematology in Germany and Austria, 2020/2021: a cross-sectional, multi-center point-prevalence study with a multi-step qualitative adjudication process

“…This finding indicates a strong discrepancy between the institutional standards of the PHOCs participating in our PPS and the German national guidelines pertaining to the management of febrile neutropenia in pediatric oncology and hematology patients. 6 …”

“…These guidelines provide physicians with information about the best care options for pediatric cancer patients with febrile neutropenia (FN). Although German guidelines for the diagnostic and therapeutic management of pediatric cancer patients with febrile neutropenia were published in 2016, 6 implementation of these guidelines in the form of a written standard for clinical practice is not compulsory. The implementation of a local antimicrobial stewardship (AMS) program also is not required.…”

Pro-inflammatory cytokine ratios determine the clinical course of febrile neutropenia in children receiving chemotherapy

“…As expected, leukocyte count increased during time of the febrile episode and this happened earlier in patients with MCG than in those with SCG. In daily routine, this parameter is not used as a predictive value for infection severity, but especially the neutrophil count is used as a parameter for termination of the antibiotic treatment [17]. Of interest, the increase of leukocyte recovery was accompanied with an increasing pro-and antiinflammatory cytokine ratio, whereas differential regulation of single cytokines was observed earlier.…”

“…Current studies suggests that PCT has better discriminatory ability than CRP [11,12]. In addition, international risk models for the assessment of severity of infection are scarce [13][14][15] and neither the common infection parameter CRP nor the highly sensitive PCT can reliably differentiate between neutropenic infections and chemotherapy-induced fever [16][17][18]. The role of cytokines in the onset of inflammation is well known.…”