Risk-adapted approach for fever and neutropenia in paediatric cancer patients – A national multicentre study

Miedema, Karin G. E.; Tissing, Wim J. E.; Abbink, Floor; Ball, Lynne M.; Michiels, Erna; Vliet, M. J. van; Vries, Wilma Y. de; Kamps, Willem A.; Norbruis, Obbe F.; Fiocco, Marta; Groot-Kruseman, Hester A. de; Wetering, Marianne D. van de; Bont, Eveline S.J.M. de

doi:10.1016/j.ejca.2015.10.065

Cited by 50 publications

(57 citation statements)

References 40 publications

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“…De-escalation should be undertaken with caution in patients with poor clinical response to antimicrobial therapy, persistent neutropenia or ongoing immunosuppressive therapy [134]. …”

Section: Introductionmentioning

confidence: 99%

Bacterial Pneumonia in Patients with Cancer

Wong¹,

Evans

2017

Clinics in Chest Medicine

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Synopsis Bacterial pneumonias exact unacceptable morbidity upon patients with cancer. While the risk is often most pronounced amongst patients with treatment-induced cytopenias, the numerous contributors to life-threatening pneumonias in cancer populations range from derangements of lung architecture and swallow function to complex immune defects associated with cytotoxic therapies and graft-vs.-host disease. These structural and immunologic abnormalities often make the diagnosis of pneumonia challenging in cancer patients and impact the composition and duration of therapy. This manuscript addresses the host factors that contribute to pneumonia susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of bacterial pneumonia in cancer patients.

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“…De-escalation should be undertaken with caution in patients with poor clinical response to antimicrobial therapy, persistent neutropenia or ongoing immunosuppressive therapy [134]. …”

Section: Introductionmentioning

confidence: 99%

Bacterial Pneumonia in Patients with Cancer

Wong¹,

Evans

2017

Clinics in Chest Medicine

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“…A pesar de que generalmente la fiebre en estos niños es secundaria a una condición infecciosa benigna (por ejemplo, una virosis), hasta 20% pueden tener una infección bacteriana grave [16][17][18] (Tabla 1). Uno de los aspectos más importantes para el manejo del paciente es la búsqueda de la "puerta de entrada" de agentes infecciosos al torrente sanguíneo.…”

Section: Búsqueda De Foco Infecciosounclassified

“…Uno de los aspectos más importantes para el manejo del paciente es la búsqueda de la "puerta de entrada" de agentes infecciosos al torrente sanguíneo. Para ponerlo en perspectiva, esto es el doble de riesgo que tienen los neonatos febriles [16][17][18] . Debido a que la reacción inflamatoria del paciente con neutropenia febril es escasa o está ausente, no focaliza adecuadamente las infecciones 4 .…”

Section: Búsqueda De Foco Infecciosounclassified

“…Otros potenciales causantes de la fiebre en estos pacientes incluyen transfusión de productos sanguíneos, fármacos citostáticos, la enfermedad neoplásica como tal, y mucositis, entre otras. Dado que estas causas no requieren de tratamiento antimicrobiano, se podría inferir que en algunos casos probablemente existe un sobre-tratamiento anti-infeccioso en niños con neutropenia febril 17 .…”

Section: Búsqueda De Foco Infecciosounclassified

“…La internación obligada de estos pacientes, a pesar de que ha mejorado dramáticamente su sobrevida, resulta en hospitalización prolongada de más de 75% de niños, sin tener una infección grave y los expone a efectos adversos de los antimicrobianos, desarrollo de resistencia bacteriana, infecciones nosocomiales, disminución de la calidad de vida, y alto costo económico para las instituciones 16,17 . Todo esto ha hecho que cada vez más se tome en consideración el riesgo que tiene un niño neutropénico de realmente tener una infección bacteriana como causa de su fiebre, así como la posibilidad de realizar un manejo más selectivo, incluyendo ciclos de antimicrobianos más cortos, egreso temprano, o inclusive manejo ambulatorio con antimicrobianos orales 3,14 .…”

Section: Evaluación Del Riesgounclassified

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Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias

Rivera-Salgado

Valverde-Muñoz

Ávila-Agüero

2018

Rev. chil. infectol.

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Gastrointestinal barrier integrity and mucosal inflammation as risk factors of blood stream infections in children treated for acute lymphoblastic leukaemia

Pietri

Weischendorff

Rathe

et al. 2023

Intl Journal of Cancer

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Chemotherapy‐induced mucositis increases the risk of blood stream infections (BSI) due to translocation of bacteria across the intestinal epithelium. Our study investigated if quantitative measures of intestinal mucositis severity, including plasma citrulline (a marker of functional enterocytes) and CCL20 (an intestinal immune homeostatic chemokine), could identify patients at risk of BSI. A total of 106 children with ALL undergoing induction treatment (NOPHO ALL 2008) were included and information regarding BSI episodes was collected from the patients' medical records. Twenty‐seven patients (25%) developed BSI during induction. Patients with BSI had a larger decrease in citrulline after chemotherapy than patients without BSI, and nearly all BSI episodes (25/27) occurred in the group of patients exhibiting a drop in citrulline (OR = 6.4 [95% CI: 1.4‐29.3], P = .008). Patients who developed BSI had higher plasma CCL20 levels on days 8, 15 and 22 than patients without BSI (all P < .05), and elevated CCL20 levels on day 8 increased the risk of subsequent BSI (OR = 1.57 [1.11‐2.22] per doubling of CCL20 level, P = .01) in a multivariable logistic regression analysis. These findings suggest that children with ALL who develop BSI during chemotherapy are characterised by more severe intestinal mucositis, as measured by plasma citrulline and CCL20. These markers may be useful in early risk stratification to guide treatment decisions.

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Risk-adapted approach for fever and neutropenia in paediatric cancer patients – A national multicentre study

Cited by 50 publications

References 40 publications

Bacterial Pneumonia in Patients with Cancer

Bacterial Pneumonia in Patients with Cancer

Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias

Gastrointestinal barrier integrity and mucosal inflammation as risk factors of blood stream infections in children treated for acute lymphoblastic leukaemia

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