Characterization of Febrile Neutropenia Management in Children With Malignancies: A Single-Center Evaluation.

Autor:	Khairullah A; Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC., Garner LM; Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC., DeMarco M; Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC., Wilson WS; Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC.
Jazyk:	angličtina
Zdroj:	The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG [J Pediatr Pharmacol Ther] 2023; Vol. 28 (3), pp. 235-240. Date of Electronic Publication: 2023 Jun 02.
DOI:	10.5863/1551-6776-28.3.235
Abstrakt:	Objective: Current recommendations for febrile neutropenia (FN) include initiation of broad-spectrum antibiotics without clear indications of when or how to de-escalate or target therapy, especially in those without microbiologically defined bloodstream infections (MD-BSIs). The purpose of this study is to characterize a pediatric FN population, FN management, and identify the proportion of patients with MD-BSI. Methods: This study was a single-center, retrospective chart review of patients admitted to the University of North Carolina Children's Hospital between January 1, 2016, and December 31, 2019, with a diagnosis of FN. Results: There were 81 unique encounters included in this study. MD-BSI was the etiology of fever in 8 FN episodes (9.9%). The most common empiric antibiotic regimen was cefepime (62%) followed by cefepime and vancomycin (25%). The most common de-escalation type was the discontinuation of vancomycin (83.3%), and the most common type of escalation was the addition of vancomycin (50%). The median antibiotic total duration in patients without MDI-BSI was 3 days (IQR, 5-9). Conclusions: In this single-center, retrospective review, most FN episodes were not due to an MD-BSI. There were inconsistencies in practice of when discontinuation of antibiotic therapy occurred in patients without MD-BSI. De-escalation or cessation of antibiotic therapy before neutropenia resolution did not result in any documented complication. These data suggest a role for implementing an institutional guideline to improve consistency in antimicrobial use in pediatric patients with febrile neutropenia. Competing Interests: Disclosures. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: membership@pediatricpharmacy.org 2023.)
Databáze:	MEDLINE
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