Trends in infection morbidity in a pediatric oncology ward, 1986-1995

Fever in neutropenia in children and adolescents: Evolution over time of main characteristics in a single center, 1993?2001

“…Our results contrast sharply, however, with the experiences reported from Innsbruck, Austria [28], where gramnegative bacteria increasingly resistant to the administered first-line antibiotic regimen became more prevalent, necessitating modifications of the antimicrobial strategy every 3 years between 1986 and 1995. Differences in the chemotherapeutic and antimicrobial therapy applied and microbiologic epidemiology may explain these contrasting results.…”

“…In contrast to other studies, only nonsignificant tendencies towards increasing proportions of episodes with [15,28], gram-negative bacteremia [6,15], and bacteremia by CoNS [15,28] were detected. This may reflect true differences between the centers.…”

“…The increase over time of the intensity of chemotherapy applied [5,6,15] is reflected by (1) the increasing relative incidence of FN in patients with PBC-ALL irrespective of relapse status; (2) the increasing proportion of patients with other malignancies who had reached complete remission when presenting with FN; and (3) the decreasing leukocyte count at presentation. This is in line with the increased relative incidence of FN reported by others [15,28]. The increased proportion of patients with central venous catheters presenting with FN simply reflects the more liberal indication to implant such a device, despite the well known risk of catheter-related infections by both gram-positive and gram-negative bacteria [2,15,27].…”

“…The increased proportion of patients with central venous catheters presenting with FN simply reflects the more liberal indication to implant such a device, despite the well known risk of catheter-related infections by both gram-positive and gram-negative bacteria [2,15,27]. In contrast to other studies reporting on earlier periods [28], the proportion of patients receiving prophylactic G-CSF support did not increase significantly, because the indications for its use remained grossly unchanged since 1993.…”

“…The purpose of these risk prediction rules is to allow for outpatient management and oral antimicrobial therapy in selected lowrisk episodes of FN. Information on possible changes over time of characteristics in pediatric FN are contradictory [6,15,21,24,28]. Such changes can require adaptation of the management of FN itself, e.g., the choice of empirical broadspectrum antimicrobial therapy and of rules predicting low-risk episodes of FN [12].…”