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Evaluation of Febrile Neutropenic Episodes of Childhood Malignancies

Year 2019, Volume: 10 Issue: 36, 6 - 9, 26.03.2019
https://doi.org/10.17944/mkutfd.489213

Abstract

Introduction:The most important side effect of therapeutics given for cancer treatment is febrile neutropenia. Neutropenia expected to be longer than seven days and severe neutropenia (absolute neutrophil count <100/mm3) especially in hematologic cancers and solid organ tumors that show bone marrow dissemination is accepted as a high-risk feature by American Infectious Disease Society. The emergent approach to a febrile neutropenia attack is to give intravascular antibiotherapy within the shortest time possible. We aimed to evaluate the febrile neutropenia attacks of pediatric cancer patients in a tertiary referral hospital during a 27-month period.

Methods:Febrile neutropenia attacks of cases treated between January 2012 and March 2014 were investigated retrospectively from the patient files. Febrile neutropenia was defined as absolute neutrophil count below 500/mm3 or between 500-1000/ mm3 but expected to fall below 500/mm3 within 48 hours in the presence of fever of 38,50C with single axillary measurement or above 380C for one hour or two measurements above 380C within 4 hours.

Results:One hundred thirty-one febrile neutropenia attacks of 48 patients were investigated retrospectively. Fever was managed within 24 hours in 69% patients. Peripheral and catheter-drawn blood cultures showed bacterial growth in 36% of the attacks, 64% of these growths being gram negative bacteria. Empirical treatment with piperacilin-taxobactam was observed to be efficient in 32% of the attacks. As a supportive treatment, cases received G-CSF in 19% of the attacks.

Conclusion:In order to, minimize morbidity and mortality of febrile neutropenia, wide spectrum antibiotics must be given intravenously within the shortest time possible in pediatric cancers.

References

  • Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA et al.; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011 Feb 15;52(4):e56-93.
  • Phillips RS, Wade R, Lehrnbecher T, Stewart LA, Sutton AJ. Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer. BMC Med. 2012 Jan 18;10:6. doi: 10.1186/1741-7015-10-6.
  • Pizzo PA, Robichaud KJ, Wesley R, Commers JR. Fever in the pediatric and young adult patient with cancer. A prospective study of 1001 episodes. Medicine (Baltimore). 1982 May;61(3):153-65.
  • Hann I, Viscoli C, Paesmans M, Gaya H, Glauser M. A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol. 1997 Dec;99(3):580-8.
  • Maxwell RR, Egan-Sherry D, Gill JB, Roth ME. Management of chemotherapy-induced febrile neutropenia in pediatric oncology patients: A North American survey of pediatric hematology/oncology and pediatric infectious disease physicians. Pediatr Blood Cancer. 2017 Dec;64(12).
  • Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004 Jan 15;100(2):228-37.
  • Boragina M, Patel H, Reiter S, Dougherty G. Management of febrile neutropenia in pediatric oncology patients: a Canadian survey. Pediatr Blood Cancer. 2007 May;48(5):521-6.
  • Delebarre M, Tiphaine A, Martinot A, Dubos F. Risk-stratification management of febrile neutropenia in pediatric hematology-oncology patients: Results of a French nationwide survey. Pediatr Blood Cancer. 2016 Dec;63(12):2167-2172.
  • Kebudi R, Vural S, Gürler N, Anak S, (tüm katılan merkezler adına). Febril nötropenik kanserli çocuklarda klinik ve mikrobiyolojik kanıtlanmış infeksiyonlar ve infeksiyon etkenleri. İçinde: Kebudi R, Anak S, Vural S (editörler). Pediatrik hematoloji-onkoloji merkezlerinde febril nötropeni tanı ve tedavi uygulamaları, çalışmaları ve sonuçları kitabı. İstanbul: İstanbul Üniversitesi; 2004.p.100-5.
  • Aslan S, Citak EC, Yis R, Degirmenci S, Arman D. Bacterial spectrum and antimicrobial susceptibility pattern of bloodstream infections in children with febrile neutropenia: experience of single center in southeast of Turkey. Indian J Microbiol. 2012 Jun;52(2):203-8.
  • Gudiol C, Bodro M, Simonetti A, Tubau F, González-Barca E, Cisnal M et al.; Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Clin Microbiol Infect. 2013 May;19(5):474-9.
  • Kar YD, Özdemir ZC, Bör Ö. Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients. Turk Pediatri Ars. 2017 Dec 1;52(4):213-220.
  • Vandercam B, Gérain J, Humblet Y, Ferrant A, Wauters G, Moreau M et al.; Meropenem versus ceftazidime as empirical monotherapy for febrile neutropenic cancer patients. Ann Hematol. 2000 Mar;79(3):152-7.
  • Erbey F, Bayram I, Yilmaz S, Tanyeli A. Meropenem monotherapy as an empirical treatment of febrile neutropenia in childhood cancer patients. Asian Pac J Cancer Prev. 2010;11(1):123-6.
  • Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol. 2009 Sep;31(9):623-9.
  • Reinecke J, Lowas S, Snowden J, Neemann K. Blood Stream Infections and Antibiotic Utilization in Pediatric Leukemia Patients With Febrile Neutropenia. J Pediatr Hematol Oncol. 2018 Aug 8.

Kanserli Çocuklarda Febril Nötropeni Ataklarının İncelenmesi

Year 2019, Volume: 10 Issue: 36, 6 - 9, 26.03.2019
https://doi.org/10.17944/mkutfd.489213

Abstract

Giriş: Kanser nedeniyle verilen tedavilerin en önemli yan etkilerinden febril nötropeni morbidite ve mortalitenin en önemli nedenidir. Amerika Enfeksiyon Hastalıkları Derneği tarafından mevcut nötropeninin yedi günden uzun sürmesinin beklenmesi ve derin nötropeni (mutlak nötrofil sayısı <100/mm3) gibi yüksek risk özelliği olarak kabul edilmektedir. Febril nötropeni atağı sırasında acil yaklaşım geniş spektrumlu antipsödomonal etkinliği olan antibiyoterapinin intravenöz yolla en kısa sürede hastaya uygulanmasıdır. Bu çalışma üçüncü basamak hizmet veren bir hastanenin 27 aylık dönemde kanserli çocukların febril nötropeni ataklarını incelemeyi amaçlamıştır.

Gereç ve Yöntem: Ocak 2012 ile Mart 2014 tarihleri arasında hematolojik veya solid organ kanseri nedeniyle tedavi edilen olgularda gelişen febril nötropeni atakları retrospektif olarak dosyalarından incelendi. Febril nötropeni; mutlak nötrofil sayısının 500/mm3 altında olması veya 500-1000/ mm3 arasında olup 48 saat içinde 500/mm3 altına düşmesi beklenen durumlara eşlik eden koltuk altından bir kez 38,5˚C ölçülen veya bir saat boyunca 38˚C üzerinde seyreden veya dört saatlik süreçte iki kez 38˚C üzerinde ölçülen ateş varlığı olarak tanımlandı. 

Bulgular: Ortalama yaşı 7,1 ± 5,3 yıl olan 48 hastanın 131 febril nötropeni atağı retrospektif olarak incelendi. Hasta grubunun %75’ini lösemi tanılı olgular oluşturmaktaydı. Ataklar sırasında ilk 24 saatte %69’unun ateş kontrolü sağlandı. Kan veya kateter kültüründe üreme atakların %36’sında, üremelerin %64’ünde ise gram negatif bir bakteri saptandı. Hastalara ampirik olarak başlanan piperasilin-tazobaktam atakların %32’sinde tedavi için yeterli oldu. Destek amacıyla atakların %19’unda granülosit koloni stimüle edici faktör uygulandı.

Tartışma:Kanserli çocuklarda kemoterapi sonrasında gelişen kemik iliği baskılanması veya başka nedenlerle kemik iliğinin çalışmadığı durumlarda hastaların morbidite ve mortalitesini en aza indirmek için geniş spektrumlu antibiyoterapi en kısa sürede başlanmalıdır.

References

  • Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA et al.; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011 Feb 15;52(4):e56-93.
  • Phillips RS, Wade R, Lehrnbecher T, Stewart LA, Sutton AJ. Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer. BMC Med. 2012 Jan 18;10:6. doi: 10.1186/1741-7015-10-6.
  • Pizzo PA, Robichaud KJ, Wesley R, Commers JR. Fever in the pediatric and young adult patient with cancer. A prospective study of 1001 episodes. Medicine (Baltimore). 1982 May;61(3):153-65.
  • Hann I, Viscoli C, Paesmans M, Gaya H, Glauser M. A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol. 1997 Dec;99(3):580-8.
  • Maxwell RR, Egan-Sherry D, Gill JB, Roth ME. Management of chemotherapy-induced febrile neutropenia in pediatric oncology patients: A North American survey of pediatric hematology/oncology and pediatric infectious disease physicians. Pediatr Blood Cancer. 2017 Dec;64(12).
  • Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004 Jan 15;100(2):228-37.
  • Boragina M, Patel H, Reiter S, Dougherty G. Management of febrile neutropenia in pediatric oncology patients: a Canadian survey. Pediatr Blood Cancer. 2007 May;48(5):521-6.
  • Delebarre M, Tiphaine A, Martinot A, Dubos F. Risk-stratification management of febrile neutropenia in pediatric hematology-oncology patients: Results of a French nationwide survey. Pediatr Blood Cancer. 2016 Dec;63(12):2167-2172.
  • Kebudi R, Vural S, Gürler N, Anak S, (tüm katılan merkezler adına). Febril nötropenik kanserli çocuklarda klinik ve mikrobiyolojik kanıtlanmış infeksiyonlar ve infeksiyon etkenleri. İçinde: Kebudi R, Anak S, Vural S (editörler). Pediatrik hematoloji-onkoloji merkezlerinde febril nötropeni tanı ve tedavi uygulamaları, çalışmaları ve sonuçları kitabı. İstanbul: İstanbul Üniversitesi; 2004.p.100-5.
  • Aslan S, Citak EC, Yis R, Degirmenci S, Arman D. Bacterial spectrum and antimicrobial susceptibility pattern of bloodstream infections in children with febrile neutropenia: experience of single center in southeast of Turkey. Indian J Microbiol. 2012 Jun;52(2):203-8.
  • Gudiol C, Bodro M, Simonetti A, Tubau F, González-Barca E, Cisnal M et al.; Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Clin Microbiol Infect. 2013 May;19(5):474-9.
  • Kar YD, Özdemir ZC, Bör Ö. Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients. Turk Pediatri Ars. 2017 Dec 1;52(4):213-220.
  • Vandercam B, Gérain J, Humblet Y, Ferrant A, Wauters G, Moreau M et al.; Meropenem versus ceftazidime as empirical monotherapy for febrile neutropenic cancer patients. Ann Hematol. 2000 Mar;79(3):152-7.
  • Erbey F, Bayram I, Yilmaz S, Tanyeli A. Meropenem monotherapy as an empirical treatment of febrile neutropenia in childhood cancer patients. Asian Pac J Cancer Prev. 2010;11(1):123-6.
  • Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol. 2009 Sep;31(9):623-9.
  • Reinecke J, Lowas S, Snowden J, Neemann K. Blood Stream Infections and Antibiotic Utilization in Pediatric Leukemia Patients With Febrile Neutropenia. J Pediatr Hematol Oncol. 2018 Aug 8.
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Articles
Authors

Ersin Töret 0000-0002-6379-8326

Tuba Hilkay Karapınar This is me 0000-0002-4714-332X

Muhammet Bulut This is me 0000-0002-5963-1267

Ahu Aksay 0000-0002-5233-0285

Yılmaz Ay 0000-0002-1693-7143

Yeşim Oymak 0000-0002-1693-7143

İlker Devrim This is me 0000-0002-6053-8027

Dilek Güneş İnce This is me 0000-0002-7914-7886

Publication Date March 26, 2019
Submission Date November 28, 2018
Acceptance Date March 5, 2019
Published in Issue Year 2019 Volume: 10 Issue: 36

Cite

Vancouver Töret E, Karapınar TH, Bulut M, Aksay A, Ay Y, Oymak Y, Devrim İ, İnce DG. Kanserli Çocuklarda Febril Nötropeni Ataklarının İncelenmesi. mkutfd. 2019;10(36):6-9.