Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients

Abstract

Aim: Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The objective of this study was to evaluate febrile neutropenic episodes in children with malignancy. Material and Methods:Sixty-eight children who received chemotherapy for malignancy between 2010 and 2015 were retrospectively reviewed. The demographic characteristics, laboratory data, infection foci, and frequency of microorganisms grown in culture were examined. Also, the frequency of febrile neutropenic attacks was investigated according to the chemotherapy periods.Results: Of the total 200 episodes, 81 (40.5%) were clinically documented, and 73 (36.5%) were microbiologically documented infections. Fever of unknown origin was observed in 46 (23%) episodes. The most frequently clinically documented focus were mucositis (33.4%) and pneumonia (24.7%). Blood culture was positive in 55 (75.3%) episodes of microbiologically documented infections. The most commonly isolated microorganisms in blood culture were Gram-negative bacteria (47.2%). C-reactive protein levels in microbiologically documented infections were higher than in clinically documented infections, and fever of unknown origin (p<0.05, for both). The most common underlying malignancy was acute lymphoblastic leukemia (73.5%). The highest proportions (34.6%) of febrile neutropenic episodes were observed during the reinduction period for these children. Nine (13.2%) children died of neutropenic sepsis. Conclusions:Febrile neutropenia continues to be an important cause of mortality in pediatric patients with malignancy. C-reactive protein levels may be an indicator for predicting bacterial infection in children with febrile neutropenia without apparent focus. The most frequently isolated agents in our center were Gram-negative microorganisms. Determining the microbial flora of each center may be beneficial to improving survival rates.

Descriptive study of adverse drug reactions in a tertiary care pediatric hospital in México from 2014 to 2017

“…The frequency of drug-related deaths identified in this study is 1.1%, which is consistent with that reported in the literature (0.1% to 13%) [32]; however, it is important to consider that there is wide variability in published values and that, as previously mentioned, ADR underreporting at HIMFG is 93.9% [38] and, thus, the problem might be underestimated. Antineoplastic and immunomodulating agents use and febrile neutropenia occurred more commonly in patients whose outcome was drug-related death, which has already been widely studied in patients on cancer treatment [49,50]. On the other hand, 0.7% of patients recovered with some sequel, which is consistent with previous reports in the literature [51].…”

Gaps in diagnosing suspected infection in immunocompromised children with cancer: A systematic review

“…Number of studies reporting the outcome(s) are indicated for each represented area. The total number of studies reporting the four assessed outcomes, respectively, were: test performance, N = 6 14,17,23,24,27,37 ; clinical course, N = 24 2,11,12,14–19,21,23,25,29,30,33,35–41,43 ; health outcomes, N = 21 2,11–13,15,18,19,22,26–29,31–33,35,36,39,41,43 ; and healthcare resource utilization (HCRU) and cost, N = 8 11,13,29,32,37,39,41,43 . *One study 37 that reported HCRU and cost, clinical course, and test performance is not shown on the Venn diagram.…”

“…This systematic review highlights distinct gaps in published data test performance, N = 6 14,17,23,24,27,37 ; clinical course, N = 24 2,11,12,[14][15][16][17][18][19]21,23,25,29,30,33,[35][36][37][38][39][40][41]43 ; health outcomes, N = 21 2,[11][12][13]15,18,19,22,[26][27][28][29][31][32][33]35,36,39,41,43 ; and healthcare resource utilization (HCRU) and cost, N = 8. 11,13,29,32,37,39,41,43 *One study 37 that reported HCRU and cost, clinical course, and test performance is not shown on t...…”

“…Twenty-four studies reported on the clinical course, including antimicrobial therapy. 2,11,12,[14][15][16][17][18][19][20][21]23,25,29,30,33,[35][36][37][38][39][40][41]43 The diagnostic impact on antimicrobial use was reported in only three studies. Two studies assessed the diagnostic impact of using samples from invasive procedures (i.e., BAL and video-assisted thoracoscopic surgery-biopsy) and determined that using such samples led to a change in antimicrobial management in 20.6%−49.5% 15,20 and 64.5% 15 of the cases with suspected infections, respectively.…”

Role of Biochemical Inflammatory Markers in Patients with Chemotherapy-Induced Neutropenia

“…Период полувыведения СРБ составляет 19 ч и не меняется ни при каких условиях [26]. Считается, что уровень данного маркера прямо коррелирует со степенью тканевого повреждения [27].…”