Meropenem in the Treatment of Febrile Neutropenic Children

Abstract

The aim of this retrospective study was to evaluate the clinical effectiveness of meropenem in immunocompromised children. Between January 1998 and December 2002 in the hemato-oncological units of our hospital meropenem was used in 87 febrile events diagnosed in 55 patients, and 328 bacterial cultures were evaluated. Microorganisms were detected and identified in 64 of the 328 hemocultures; there was a predominance of gram-positive strains (67%). In 49.4% the infection was documented microbiologically. In 16 additional cases the infection was proven clinically and 32.2% of the episodes were considered to be fever of unknown origin. The success rate of the meropenem therapy-excluding the proven fungal or coagulase-negative Staphylococcus infections--was 72.9% and for the whole cohort 49.4%. The results demonstrate that meropenem is effective and well-tolerated when used for the treatment of neutropenic cancer children.

Comparison of Sulbactam-Cefoperazone with Carbapenems as Empirical Monotherapy for Febrile Neutropenic Children with Lymphoma and Solid Tumors

“…In the literature, different rates, such as 22.9% [19], 40% [35], and 52% [25], have been reported and the wide range of rates may be due to the different patient profiles, and different evaluation of the patients in the studies. The rates of microbiologically documented infections vary between 30% and 50% [19,22,35]. In our study, the rate of MDI was 19.7%, which was a relatively low rate.…”

“…In the literature it was reported that, although it varied from center to center, the focus of infection was unknown in nearly half of febrile neutropenia episodes, and that the only infection finding in these patients was fever [25,40,42]. On the other hand, previous studies reported that the rate of FUO in these patients were 18% [22] and 80% [23]. In detecting clinically documented infections, the experience and the attention of the clinician and the clinical follow-up of the patient are particularly important.…”

“…On the other hand, the effectiveness of carbapenem group antibiotics in the treatment of childhood febrile neutropenia was shown by meta-analysis [39] and other studies [22,25]. In the present study, in order to achieve more reliable results, we compared the efficacy of SC with carbapenems, with proven efficacy as monotherapy.…”

“…Recent studies in the literature and a previous study carried out at our center [20] showed that gram-positive bacterial growth was more common in recent years [1,19,22,40]. However, Chastagner et al [23] reported a gram-negative bacterial growth rate of 60%.…”

“…In the empirical treatment of febrile neutropenic children with cancer, effective monotherapies are piperacillin-tazobactam [15], ceftazidime [16][17][18], cefepime [17,[19][20][21], and carbapenem group [19,20,22] antibiotics. Some combination regimens include cefepime plus amikacin [23,24], piperacillin-tazobactam plus netilmicin [25,26], and meropenem plus amikacin [25] combinations.…”