A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients.

Autor: Whitehurst DA; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA., Friedman DL; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA., Zhao Z; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Sarma A; Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Snyder E; Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Dulek DE; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.; Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA., Banerjee R; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.; Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA., Kitko CL; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA., Esbenshade AJ; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2024 Mar; Vol. 71 (3), pp. e30818. Date of Electronic Publication: 2023 Dec 18.
DOI: 10.1002/pbc.30818
Abstrakt: Background: Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count < 500/μL) often undergo an evaluation for invasive fungal disease (IFD) and other infections. Current literature suggests that beta-D-glucan (BDG), galactomannan, bronchoalveolar lavage (BAL), and computed tomography (CT) scans (sinus, chest, and abdomen/pelvis) may help determine a diagnosis in this population.
Methods: In a retrospective cohort study of all cancer/stem cell transplant patients (diagnosed 2005-2019) from one pediatric hospital, all episodes with prolonged febrile neutropenia or IFD evaluations (defined as sending a fungal biomarker or performing a CT scan to assess for infection) were identified.
Results: In total, 503 episodes met inclusion criteria and 64% underwent IFD evaluations. In total, 36.4% of episodes documented an infection after initiation of prolonged febrile evaluation, most commonly Clostridioides difficile colitis (6.4%) followed by a true bacterial bloodstream infection (BSI) (5.2%), proven/probable IFD (4.8%), and positive respiratory pathogen panel (3.6%). There was no difference in sinus CTs showing sinusitis (74% vs 63%, p = 0.46), whereas 32% of abdomen/pelvis CTs led to a non-IFD diagnosis, and 25% of chest CTs showed possible pneumonia. On chest CT, the positive predictive value (PPV) for IFD was 19% for nodules and 14% for tree and bud lesions. BDG had a PPV of 25% for IFD and GM 50%. BAL diagnosed IFD once and pneumocystis jirovecii pneumonia twice.
Conclusions: Chest CTs and abdomen/pelvis CTs provide clinically relevant information during the prolonged febrile neutropenia evaluation, whereas BDG, galactomannan, BAL, and sinus CTs have less certain utility.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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