Febrile Neutropenia in Children with Cancer

Abstract

Febrile neutropenic patients are at high risk of bacterial sepsis. Prompt initiation of empiric antimicrobial therapy has been critical in reducing mortality and morbidity in those patients (Viscoli, 2005). A variety of empiric antibiotic regimens can be used for FN. While published guidelines are useful, they cannot

An analysis of the resource use and costs of febrile neutropenia events in pediatric cancer patients in Australia

“…1 Available data indicate unplanned admissions due to FN represent a high burden in terms of their impact on patient and caregiver quality of life 2 and an increased use of healthcare resources. 3 Patients experiencing an FN event, including in the pediatric setting, are heterogeneous and have different risk factors impacting prognosis and outcomes. 1 This has led to the development and validation of several clinical decision rules (CDRs) that identify patients who are at low risk of developing severe infections or complications.…”

“…These events are typically managed in‐hospital using intravenous antibiotics, with the duration depending on blood culture results, fever resolution, a rising neutrophil count, and underlying cancer treatment status 1 . Available data indicate unplanned admissions due to FN represent a high burden in terms of their impact on patient and caregiver quality of life 2 and an increased use of healthcare resources 3 …”

Different fever definitions and the rate of fever and neutropenia diagnosed in children with cancer: A retrospective two‐center cohort study

“…The first criterion, severe neutropenia, is quite uniformly defined and applied in pediatric oncology practice, as an absolute neutrophil count ≤0.5 G/L or ≤1.0 G/L and expected to rapidly decline 1. The second criterion, however, the temperature limit defining fever, relevantly varies between different pediatric oncology centers, even within the same country 4. The temperature limit clinically applied varied from 37.5 to 39.0°C in 21 centers in the United Kingdom in 2005 5, and from 38.0 to 39.0°C in 9 centers in Switzerland in 2012 (unpublished data).…”

Effect of meropenem with or without immunoglobulin as second‐line therapy for pediatric febrile neutropenia

“…Survival of children with hematological disease and cancer has increased dramatically, but life‐threatening complications due to bacterial infections occur in 5–10% of febrile episodes in pediatric cancer patients . Monotherapy has become a possibility with the availability of broad‐spectrum antibiotics, such as third‐ and fourth‐generation cephalosporins with anti‐pseudomonal activity (ceftazidime and cefepime), ureidopenicillins with β‐lactamase inhibitors, and carbapenems . In adults, piperacillin/tazobactam, carbapenem and cefepime have been recommended for first‐line therapy in high‐risk febrile neutropenia patients .…”

“…1,2 Monotherapy has become a possibility with the availability of broad-spectrum antibiotics, such as third-and fourth-generation cephalosporins with antipseudomonal activity (ceftazidime and cefepime), ureidopenicillins with β-lactamase inhibitors, and carbapenems. [3][4][5][6] In adults, piperacillin/tazobactam, carbapenem and cefepime have been recommended for first-line therapy in high-risk febrile neutropenia patients. 7 There have been many reports, including our previous reports, on pediatric febrile neutropenia showing rates of success of approximately 40-70%, [8][9][10][11] but there have been very few reports on second-line therapy for febrile neutropenia.…”