Treatment of pediatric febrile neutropenia in the era of vancomycin‐resistant microbes

Abstract

Ours is the first study to survey current practices in the treatment of pediatric FN and to document changes in practice patterns due to emerging antibiotic resistance patterns. We demonstrate increased use of monotherapy for FN, and a 57% decrease in the use of VN. Local considerations influence antibiotic choices with a significant difference in VRE prevalence between those centers that continue to use VN as compared to those that have discontinued it.

Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: A descriptive study

“…Similar increase in isolation rate of methicillin resistant Staphylococcus aureus (MRSA) was also reported in another study from Taiwan [ 20 ]. Moreover emergence of vancomycin resistant Enterococcus species (VRE) not only poses a therapeutic challenge for febrile neutropenic patients [ 21 , 22 ] but also indirectly reflects irrational usage of vancomycin and poor infection control practices. The increasing rates of antimicrobial resistance amongst both Gram-positive and Gram-negative pathogens isolated from patients with neutropenia are posturing new therapeutic challenges.…”

“…The increasing rates of antimicrobial resistance amongst both Gram-positive and Gram-negative pathogens isolated from patients with neutropenia are posturing new therapeutic challenges. These challenges are compounded by the fact that relatively few new drugs are being developed, particularly those that treat resistant Gram-negative organisms [ 22 ]. As these trends are often associated with local treatment practices [ 22 , 23 ] therefore, we suggest rational use of broad-spectrum antibiotics especially carbapenem and vancomycin to prevent increasing resistance against them.…”

Suspected infections in children treated for ALL

“…The initial antibiotic treatment in the two study centres is somewhat different as is often the case in different countries (15,30,32,33). In Iceland, the initial treatment is piperacillin and aminoglycoside, whereas the empirical treatment in southern Sweden is usually imipenem or ceftazidime.…”

“…The treatment needed to be adjusted or altered in one‐third of the episodes; usually antibiotics with extended spectrum toward Gram‐positive bacteria were often added to the treatment. Colony‐stimulating factors are at this time not included in the empirical therapy, but beneficial effects of this treatment has been reported (15,30,33). Apparently, the treatment regimens in both centres seem to be appropriate considering the types of bacteria cultured.…”

Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA

“…Our response rate of 34% was lower compared with other physician surveys [1,6,25,29]. As with any survey, the study results only represent prescribing practice patterns of responding physicians; they are limited by nonresponse and selection bias and by concerns of accuracy and recall bias for the responses of individuals.…”