The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis

Lucas, Kenneth G.; Brown, Arthur E.; Armstrong, Donald; Chapman, Douglass; Heller, Glenn

doi:10.1002/(sici)1097-0142(19960215)77:4<791::aid-cncr27>3.0.co;2-v

Cited by 165 publications

(70 citation statements)

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“…Bacteremia, caused mainly by gram-positive bacteria (S. epidermides, streptococci, enterococci) and by aerobic gram-negative bacteria (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli), often affects 10% to 20% of febrile patients. 9 Figure 1 shows the new protocol of the American Academy of Oncology for antibiotic therapy in febrile neutropenic patients 10 ; however each case should be assessed on an individual basis, considering the most probable agents, respecting the profile of sensitivity and resistance of each institution and community.…”

supporting

confidence: 68%

Suporte de terapia intensiva no paciente oncológico

Sapolnik¹

2003

J. Pediatr. (Rio J.)

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Objective: To review the most important aspects of the clinical presentation and treatment of children with cancer in intensive care units. Medline (1970Medline ( to 2003; search terms: children, cancer, oncology, intensive care, complications. General and pediatric oncology textbooks. Sources of data: Summary of the findings:Practically all organs may be affected by cancer or by its treatment. The main complications include infections, hematological problems and electrolyte/ metabolic disturbances. Intensive care therapy is necessary to correct organic dysfunctions (cardiovascular, respiratory, renal, gastrointestinal, and neurologic). Nutritional and emotional support, as well as pain control are fundamental aspects for recovery in children. The intensivist should be alert to interrupt intensive care measures if required. Conclusions:Many studies show that the use of intensive care therapy in children with cancer is not futile, with a reduction in mortality and improvement in the quality of life of these children in the medium and long terms.

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supporting

confidence: 68%

Suporte de terapia intensiva no paciente oncológico

Sapolnik¹

2003

J. Pediatr. (Rio J.)

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“…This is consistent with studies in adult population [5]. Similarly, pediatric studies have identified de-novo or relapsed leukemia as a high risk factors for bacterial infection [18,20].…”

Section: Resultsmentioning

confidence: 99%

Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Matloob¹

2016

Journal of Microbiology and Infectious Diseases

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Objective: Pediatric cancer patients with prolonged febrile neutropenia have increased risk for severe, recurrent or new bacterial and fungal infection. The aim of this study was to identify the risk factors associated with adverse outcomes in this group. Methods:We retrospective analyzed the clinical data of 135 hospitalizations of pediatric cancer patients with prolonged febrile neutropenia from a tertiary health care center of Pakistan. Results:The mean age of the study population was 7.3±4.1 years. There were 98 (72.6%) males and 37 (27.4%) females. Acute leukemia with 88 patients (65.2%) was the most common diagnosis followed by lymphomas 19 patients (14.1%) and solid tumors. Cause of febrile neutropenia was identified in only 58 (43.0%) patients, out of them blood stream infections were found in 22 cases (16.3%), pneumonia in 15 (11.1%), fungal infection in 13 (9.6%), infectious diarrheas in 5 (3.7%) and urinary tract infection (UTI) in 3 (2.2%) of cases. The composite adverse event outcome was observed in 28 (20.7%) of patients, with in-hospital mortality occurring in 7 (5.2%), Pediatric intensive care unit (PICU) admission occurring in 12 (8.9%) and inotropic support was required in 9 (6.7%). On logistic regression analysis AML (Adjusted odds ratio (AOR), 7.6; P<0.001), neutropenia <50/mm 3 (AOR, 10.8; p<0.001), platelets count <50,000/mm 3 (AOR, 5.2; p<0.001), BSI (AOR, 2.3; p 0.05) and fungal infection (AOR, 4.3; p<0.001) were found as independent risk factors for composite adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia.Conclusions: AML, severe myelosuppression, blood stream infections and fungal infection were identifiable risk factors associated with development of adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia. J Microbiol Infect Dis 2016;6(2): 69-73Key words: Febrile neutropenia, pediatric, oncology, adverse outcome Uzamış Febril Nötropeni ile Pediatrik Kanser Hastalarında Karma Olumsuz Durum SonuÖZET Amaç: Uzamış febril nötropeni pediatrik kanserli hastalarında ağır seyirli yeni tanı veya tekrarlayan bakteri ve mantar enfeksiyonu riski artmıştır. Bu çalışmanın amacı, bu grupta olumsuz sonuçlarla ilişkili risk faktörlerini belirlemektir.Yöntemler: Pakistan'ta bir üçüncü basamak sağlık merkezine uzamış febril nötropeni nedeni ile izlenen pediatrik kanser hastalarının 135 hastane yatış epizotu retrospektif olarak analiz edildi. Bulgular: Çalışma grubunun yaş ortalaması 7,3 ± 4,1 yıl idi. Hastaların 98'i (% 72,6) erkek ve 37'si (% 27,4) kadındı. Akut lösemi 88 hastada (% 65,2) ile birinci sırada, lenfoma 19 hasta (% 14,1) ile ikinci sırada idi ve diğer hastalarda solid organ tümörleri en sık görülen tanı olarak saptandı. Febril nötropenin nedeni sadece 58 (% 43,0) hastada tanımlandı. Bu hastalardan 22 olguda (% 16,3) kan akımı enfeksiyonu (KAE), 15 hastada pnömoni (% 11,1), fungal infeksiyon 13 (% 9,6) hastada, ve enfeksiyöz diyare 5 hastada (% 3,7) ve üriner sitem enfeksiyonu 3 (% 2,2) hastada saptandı. Karma olumsu...

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“…9,10 A prolonged period of neutropenia (more than 10 days), hypotension, severe mucositis, inadequate food intake, dehydration and altered mental status are recognized high-risk factors associated with life-threatening febrile neutropenia. 9,11,12 Talcott et al 10 showed that the complication rate in patients with fever and neutropenia was 34% if risk factors were present, and only 5% if they were absent. In contrast to studies including patients with an expected neutropenia of Ͻ10 days, 8,13,14 we demonstrate that BC and MM patients up to the age of 63 years in stable clinical condition (Karnofsky у70 ) receiving HDCT with PBSCT who have febrile neutropenia lasting at least 10 days are candidates for outpatient treatment, independent of the underlying disease.…”

Section: Discussionmentioning

confidence: 99%

“…12 This approach can improve quality of life and, as has been demonstrated in the present study, is safe and effective in patients with BC and MM after HDCT and PBSCT. We do not recommend this procedure for older patients or patients autografted for leukemia.…”

Section: Discussionmentioning

confidence: 99%