Fever and Neutropenia in Pediatric Patients with Cancer

Meckler, Garth; Lindemulder, Susan

doi:10.1016/j.emc.2009.04.007

Cited by 61 publications

(55 citation statements)

References 97 publications

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“…A pesar de que la temperatura rectal tiene mayor sensibilidad, se prefiere la medición de la temperatura axilar teniendo en cuenta el riesgo potencial de translocación bacteriana si el paciente cursa con mucositis 7 .…”

Section: Fiebreunclassified

“…Una década atrás la letalidad del paciente pediátrico con neutropenia febril era del 10%, actualmente se reporta una frecuencia que oscila entre 2% a 6% en niños 5,6 . El paciente oncológico se encuentra más expuesto a padecer infecciones debido a su estado de inmunosupresión, ya sea por los efectos producidos por su enfermedad de base o por el manejo instaurado para la misma 7 . Durante el tratamiento antineoplásico los agentes citotóxicos son administrados junto con otras terapias inmunosupresoras 7,8 , lo que produce efectos secundarios múltiples en el organismo, creando alteraciones en el sistema inmune, tanto innato como adaptativo y favoreciendo la invasión por diferentes microorganismos.…”

Section: Introductionunclassified

“…El paciente oncológico se encuentra más expuesto a padecer infecciones debido a su estado de inmunosupresión, ya sea por los efectos producidos por su enfermedad de base o por el manejo instaurado para la misma 7 . Durante el tratamiento antineoplásico los agentes citotóxicos son administrados junto con otras terapias inmunosupresoras 7,8 , lo que produce efectos secundarios múltiples en el organismo, creando alteraciones en el sistema inmune, tanto innato como adaptativo y favoreciendo la invasión por diferentes microorganismos. A nivel del sistema innato, se rompe la barrera cutánea con el uso de catéteres, se produce inflamación y lesión de las mucosas debido a la quimioterapia lo cual permite la invasión de agentes patógenos.…”

Section: Introductionunclassified

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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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Section: Fiebreunclassified

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Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

2015

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“…A recent systematic review of randomized control trials in pediatric FN [37] concluded that antipseudomonal penicillin and fourth-generation cephalosporin monotherapy were associated with similar failure and mortality rates as aminoglycoside containing combination therapy. The current recommendations also advise monotherapy as initial empirical antibiotic therapy in pediatric FN [3][4][5][6][7][8][9]. Further, Outpatient management and oral antibiotics were found to be safe in low-risk FN with no infection-related mortality observed in any patient and no significant differences in outcomes compared with inpatient management and intravenous therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Attributes that guides the management considerations in FN include: (1) fever in a neutropenia child is considered to be due to infection unless proved otherwise; (2) microbiological diagnosis is possible in only about 10-30% cases of pediatric FN [4]; Organisms with low virulence or those considered as potential contaminants in an immunocompetent patient can lead to serious infection in presence of neutropenia; (3,4) co-infection with multiple organisms are common and untreated infection can rapidly disseminate and lead to fatality. Among the infectious causes of FN in children, bacteria outnumber other agents (viral, fungal and parasitic); discussion in this paper will be limited to microbiology of bacterial agents in FN only.…”

Section: Introductionmentioning

confidence: 99%

Changing Microbiological Pattern of Pediatric Febrile Neutropenia

Mandal¹,

Singh²

2016

J Antimicrob Agents

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Does age play a role in fever and neutropenia events and complications: A comparison of adolescents versus younger children with cancer at a tertiary care pediatric hospital, a pilot project

2022

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Background Adolescents and young adults with cancer (AYA) are a complex group of patients. The development of fever and neutropenia (FN) is a potentially lethal complication of chemotherapy. Risk stratification of patients with FN has become increasingly valuable allowing for early intervention and to guide treatment type and duration appropriately. There are risk stratification guidelines that exist, but most are validated in young children with cancer (YCWC). AYA are frequently shown to have more numerous and severe side effects from chemotherapy. Aims This study aimed to identify whether age contributes to the incidence and severity of FN. Methods and Results Patients diagnosed with a malignancy in a 5‐year period at our institution were included from ages 0–18 years. We reviewed details of their FN events, including duration of hospital admission, source (bacterial/fungal), PICU admission and duration, positive blood cultures and mortality. Adolescents with cancer (AWC) had a trend of being 1.56 times more likely to have FN events (CI 95% 0.936–2.622, p = 0.087). Assessment of the duration of PICU stay showed that AWC were 4.9 times more likely to have longer admissions (CI 95% 0.998–24.067, p = 0.050). There was no significant difference between the two groups in the rate of PICU admission, positive cultures, identification of a bacterial or fungal source, hospital admission duration or mortality from FN. Conclusion This study demonstrated a trend towards AWC being more likely to develop FN events. When such events occur in this group, the severity of them may be heightened as evidenced by longer duration of PICU admission.

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Fever and Neutropenia in Pediatric Patients with Cancer

Cited by 61 publications

References 97 publications

Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

Changing Microbiological Pattern of Pediatric Febrile Neutropenia

Does age play a role in fever and neutropenia events and complications: A comparison of adolescents versus younger children with cancer at a tertiary care pediatric hospital, a pilot project

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