Short Courses of Intravenous Empirical Antibiotic Treatment in Selected Febrile Neutropenic Children with Cancer

Lehrnbecher, Thomas; Stănescu, Anca Daniela; Kühl, Joachim

doi:10.1007/s15010-002-2094-1

Cited by 37 publications

(23 citation statements)

References 33 publications

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“…[5,16] Fungal as well as bacterial infections may also underlie this problem as evidenced by response to empiric antifungal agents and antibiotics. [20,21] With regard to the frequency of clinically or microbiologically documented sites of infections in our study, blood stream infection was responsible for the majority of cases, which is similar to the fi ndings in other studies. [1,7,15,22] Interestingly, bacteremia was even observed in asymptomatic neutropenic patients.…”

Section: Discussionsupporting

confidence: 90%

Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

et al. 2010

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blood stream infection and fever of unknown origin are the most common nosocomial infections in pediatric hematology/oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly Gram-positive pathogens with a high incidence of methicillin-resistant S. aureus, extended spectrum beta lactamase and vancomycin resistant enterococci organisms.

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Section: Discussionsupporting

confidence: 90%

Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

et al. 2010

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“…Major factors to consider when choosing empirical therapy for febrile neutropenic patients, based on the literature review (6, 8, 9, 18-24, 26, 31, 35-43, 51, 53, 54 © F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3 tional studies in children and adults also show that, although the discontinuation of antibiotics is associated with relapse of fever in a few neutropenic patients, there is no increase in mortality, providing the antibacterials are re-started immediately if fever recurs. [63][64][65][66][67][68][69][70][71] These studies included patients with prolonged neutropenia, and, therefore, classically judged to be at high risk of bacterial infection. [63][64][65][67][68][69][70][71][72][73][74][75] Evidence of bone marrow recovery was required before stopping antibiotics in only a minority of these studies.…”

mentioning

confidence: 99%

“…[63][64][65][66][67][68][69][70][71] These studies included patients with prolonged neutropenia, and, therefore, classically judged to be at high risk of bacterial infection. [63][64][65][67][68][69][70][71][72][73][74][75] Evidence of bone marrow recovery was required before stopping antibiotics in only a minority of these studies. [63][64][65]67,70 In two observational studies, empirical therapy was even stopped in neutropenic patients regardless of continued fever.…”

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confidence: 99%

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

et al. 2013

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Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'deescalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance. ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3 increasing resistance. The draft of these guidelines was discussed by the Expert Group at the ECIL-4 meeting in September 2011 and considers: i) bacterial epidemiology in neutropenic patients; ii) risk factors for resistance; iii) escalation and deescalation approaches; iv) the appropriate duration of empirical therapy; iv) non-conventional therapies against multi-resistant pathogens; and v) other issues on the management of bacterial infections in these patients. Up-dated slide sets from ECIL-4 covering these aspects are available on the websites of the four organizations involved in ECIL: the European Group for Blood and Marrow Transplantation, the European Organisation for Research and Treatment of Cancer, the Immunocompromised Host Society (ECIL), and the European Leukaemia Net. 12,13 This article summarizes the main ECIL recommendations on the initial empirical therapy of bacterial infections, but will also be valuable for the management of the many nonneutropenic but severely-immunosuppressed hematology patients. MethodsThe methodology of the ECIL conferences has been described previously. 11A working group of experts in the field of infectious diseases, microbiology or hematology was constituted, and reviewed the published literature in order to prepare proposals covering the following aspects: 1) empirical antibiotic therapy for...

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“…. [20][21][22][23][24]. Dans notre étude, nous avons choisi de proposer un relais de l'antibiothérapie par voie orale à H72, malgré la persistance de la neutropénie, en l'absence de fièvre et de documentation bactériologique chez un enfant en bon état général compliant à la prise orale des antibiotiques et pour lequel la PCT était infé-rieure à 0,12 mg/L au moment de la prise en charge de la NF.…”

Section: Discussionunclassified

Mise en place de recommandations thérapeutiques pour la prise en charge des neutropénies fébriles chez les enfants atteints de cancer : expérience du RIFHOP

Carrer

Saulpic

Dubrel

et al. 2014

Revue d'Oncologie Hématologie Pédiatrique

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Short Courses of Intravenous Empirical Antibiotic Treatment in Selected Febrile Neutropenic Children with Cancer

Abstract: Discontinuation of intravenous antibiotics regardless of ANC or evidence of bone marrow recovery seems safe and effective in pediatric cancer patients with FUO when children are afebrile for at least 24 h and are treated for a minimum of 72 h.

Cited by 37 publications

References 33 publications

Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

Mise en place de recommandations thérapeutiques pour la prise en charge des neutropénies fébriles chez les enfants atteints de cancer : expérience du RIFHOP

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