Risk-adapted approach for fever and neutropenia in paediatric cancer patients--a national multicentre study

Autor: Marta Fiocco, Eveline S. J. M. de Bont, Hester A. de Groot-Kruseman, Wim J. E. Tissing, Wilma Y. de Vries, Karin G. E. Miedema, Marianne D. van de Wetering, Lynne M. Ball, Michel J. van Vliet, Erna M.C. Michiels, Willem A. Kamps, Floor Abbink, Obbe F. Norbruis
Přispěvatelé: CCA -Cancer Center Amsterdam, Paediatric Oncology, Pediatrics, Pediatric surgery, CCA - Clinical Therapy Development, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Stem Cell Aging Leukemia and Lymphoma (SALL)
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Male
Cancer Research
Antibiotics
Bacteremia
0302 clinical medicine
Neoplasms
Ambulatory Care
Prospective Studies
Chemotherapy-Induced Febrile Neutropenia
Prospective cohort study
Child
Infusions
Intravenous
Children
OUTPATIENT
ANTIMICROBIAL THERAPY
INVASIVE BACTERIAL-INFECTION
ANTIBIOTIC MANAGEMENT
Anti-Bacterial Agents
Hospitalization
Oncology
030220 oncology & carcinogenesis
Child
Preschool
Absolute neutrophil count
Female
Risk assessment
medicine.medical_specialty
Neutropenia
Adolescent
INDUCED FEBRILE NEUTROPENIA
Fever
medicine.drug_class
Antineoplastic Agents
Risk Assessment
Drug Administration Schedule
Sepsis
03 medical and health sciences
CHEMOTHERAPY-INDUCED NEUTROPENIA
SDG 3 - Good Health and Well-being
030225 pediatrics
Internal medicine
medicine
Humans
Intensive care medicine
PROCALCITONIN
Gram-Positive Bacterial Infections
IL-8
business.industry
Infant
Newborn
Infant
medicine.disease
PREDICTIVE-VALUE
Risk assessment model
ONCOLOGY PATIENTS
business
Febrile neutropenia
Zdroj: European journal of cancer (Oxford, England, 53, 16-24. Elsevier Limited
European Journal of Cancer, 53, 16-24
European Journal of Cancer, 53, 16-24. Elsevier Ltd.
European Journal of Cancer, 53, 16-24. Pergamon
European Journal of Cancer, 53, 16-24. ELSEVIER SCI LTD
Miedema, K G E, Tissing, W J E, Abbink, F C H, Ball, L M, Michiels, E M C, van Vliet, M J, de Vries, W Y, Kamps, W A, Norbruis, O F, Fiocco, M, de Groot-Kruseman, H A, van de Wetering, M D & de Bont, E S J M 2016, ' Risk-adapted approach for fever and neutropenia in paediatric cancer patients--a national multicentre study ', European Journal of Cancer, vol. 53, pp. 16-24 . https://doi.org/10.1016/j.ejca.2015.10.065
ISSN: 0959-8049
DOI: 10.1016/j.ejca.2015.10.065
Popis: Background: In this national multicentre study, we examined the safety of reducing antibiotics in selected paediatric cancer patients with febrile neutropenia.Methods: Patients with signs of a bacterial infection and/or abnormal vital signs indicating sepsis were considered high risk and received antibiotic therapy. Remaining patients were allocated to low-or medium risk, depending on their interleukin-8 level. Low-risk patients did not receive any antibiotics and were discharged from the hospital after having been afebrile for 12 h. Medium-risk patients were re-evaluated after 72 h of antibiotic treatment and, in selected patients, antibiotics were stopped.Results: Two hundred thirty-three febrile neutropenic episodes in 141 paediatric cancer patients were included in the study. Sixty-four episodes were classified high risk (28%), 122 medium risk (52%), and 47 (20%) low risk. In the medium-risk group, antibiotics were stopped after 72 h in 50 in 122 episodes (41%). Median duration of antibiotic treatment and hospital admission was significantly lower in low-and medium-risk episodes with early discharge. No failures were observed in the medium-risk group with early discharge. In the low-risk group, six failures were observed (12.8%), due to coagulase-negative staphylococci-positive blood cultures and recurrent fever.Conclusion: We showed that it is safe to shorten antibiotic treatment to 72 h in selected medium-risk patients with febrile neutropenia, regardless of the neutrophil count. The safety of withholding antibiotics in selected low-risk paediatric cancer patients with febrile neutropenia requires further investigation, using more suitable definitions for safety. Reduction in hospital admissions allows children with cancer more time at home and consequently improves their quality of life. (C) 2015 Elsevier Ltd. All rights reserved.
Databáze: OpenAIRE
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