La neutropenia: Una revisión narrativa / Neutropenia: A narrative review

Introducción: La Neutropenia constituye una de las complicaciones más comunes en pacientes que reciben tratamiento sistémico con quimioterapia, siendo esta una población heterogénea; por lo tanto su presentación clínica es inespecífica, pudiendo presentarse de manera asintomática o inclusive evidenciar cuadros muy severos con signos de sepsis grave. Ante lo referido, en la actualidad los grupos de trabajo requieren determinar de manera consistente los diferentes factores de riesgo que contribuyen a la presentación de neutropenia, con el objetivo de estratificar de manera óptima al paciente y así disminuir complicaciones. Puntos importantes: Este trabajo se enfatiza en analizar los factores de riesgo; tanto del paciente, la enfermedad y el tratamiento; de acuerdo a los sistemas de estratificación como MASCC, CISNE. Además se evaluaron los fundamentos clínicos y microbiológicos para categorizar al paciente e incluir medidas de soporte profiláctico a los grupos con mayor fragilidad, disminuyendo el alto riesgo de complicaciones severas. Conclusión: La neutropenia es un evento adverso indeseable en el manejo del tratamiento oncohematológico. Los sistemas de estratificación de riesgos MASCC y CISNE son herramientas útiles para seleccionar pacientes de bajo riesgo. Sin embargo, otros factores, como el tipo de tumor y el tipo de infección, pueden influir en la estratificación. Por lo tanto, es importante manejar a cada paciente de forma individualizada.El inicio de la profilaxis antimicrobiana y el uso de FECG pueden ayudar a reducir la morbimortalidad.

Introduction: Neutropenia is one of the most common complications in patients receiving systemic treatment with chemotherapy; this is a heterogeneous population; therefore, its clinical presentation is nonspecific, presenting asymptomatically or even showing very severe symptoms with signs of severe sepsis. Given those above, currently, the working groups need to consistently determine the different risk factors contributing to the presentation of neutropenia to stratify the patient and thus optimally reduce complications. Important points: This work emphasizes the analysis of risk factors, including the patient, the disease, and the treatment, according to stratification systems such as MASCC and CISNE. In addition, the clinical and microbiological foundations were evaluated to categorize the patient and include prophylactic support measures for the most frail groups, reducing the high risk of severe complications. Conclusion: Neutropenia is an undesirable adverse event in managing oncohaematological treatment. The MASCC and CISNE risk stratification systems are valuable tools for selecting low-risk patients. However, other factors, such as the type of tumor and infection, may influence the stratification. Therefore, it is essential to manage each patient individually. The initiation of antimicrobial prophylaxis and the use of FECG can help reduce morbidity and mortality.

Prevalencia de gérmenes con multi resistencia antibiótica en bacteriemia asociada a neutropenia febril en pacientes oncológicos hospitalizados. Un estudio de centro único / Prevalence of germs with multi antibiotic resistance in bacteremia associated with febrile neutropenia in hospitalized cancer patients. A single-center study

Introducción: El cáncer en el año 2020 provoco 1,4 millones de muertes, el 47% en personas menores de 65 años de edad,la neutropenia febril en el paciente oncológico aumenta los casos de infecciones graves, incrementando la morbimortalidad cuando no se ha empezado un tratamiento de oportuno. El objetivo del presente estudio fue describir una población con esta patología en un centro de referencia regional. Metodología: Este estudio transversal, se realizó en el Instituto Oncológico Nacional "Dr. Juan Tanca Marengo", Sociedad de Lucha contra el Cáncer, Solca Guayaquil, período enero 2020-junio 2021, con una muestra no probabilística, de pacientes con neoplasias, neutropenias y cultivos positivos. Se registraron variables demográficas, clínicas, de laboratorio. Se utiliza estadística descriptiva invariada. Resultados: Se analizan 126casos, de edad promedio 55 años, el 50.8% fue de sexo femenino; el 88.1 % ingresó con neutropenia febril; la estancia hospitalaria promedio fue de 7 días. La Escherichia coli fue el microorganismo más frecuente con el 17.5 %, seguido por Klebsiella neumonía en el 9.5 %, Enterobacteria aerógenas y Pseudomonas eruginosa en el 4.8 %. El 70.2 % de las bacterias aisladas presentó resistencia bacteriana, el 47 % fueron bacterias betalactamasa de espectro ampliado (BLEA), el 40 % fue betalactamasa de espectro extendido (BLEE), y el 5 % productor de carbapenémicas (KPC), el 57.5 % con resistencia bacteriana tuvo una estancia hospitalaria mayor a 7 días Conclusión: El principal microorganismo fue Escherichia coli y la resistencia mayormente la tuvieron las bacterias betalactamasa de espectro ampliado positiva; permitiendo conocer la epidemiología local del perfil microbiológico y su relación con los pacientes oncológicos con neutropenia febril

In troduction:Cancer in 2020 caused 1.4 million deaths, 47% in people under 65 years of age, febrile neu-tropenia in cancer patientsincreases cases of serious infections, increasing morbidity and mortality when Timely treatment has not been started. The objective of the present study was to describe a pop-ulation with this pathology in a regional reference center.Met hodology: This cross-sectional study was conducted at the National Oncology Institute "Dr. Juan Tanca Marengo," Society for the Fight Against Cancer, Solca-Guayaquil, period January 2020-June 2021, with a non-probabilistic sample of patients with neoplasms, neutropenia, and positive cultures. Demo-graphic, clinical, and laboratory variables were recorded. Univariate descriptive statistics are used.R esults: 126 cases were analyzed, with an average age of 55 years; 50.8% were female; 88.1% were admitted with febrile neutropenia; the average hospital stay was seven days. Escherichia coli was the most frequent microorganism with 17.5%, followed by Klebsiella pneumoniae in 9.5%, Enterobacter aerogenes, and Pseudomonas aureginosa in 4.8%. 70.2% of the isolated bacteria presented bacterial resistance, 47% were extendedspectrum beta-lactamase bacteria (ESBL), 40% were extended-spectrum betalactamase (ESBL), and 5% produced carbapenemases (KPC), 57.5% with bacterial resistance had a hospital stay greater than seven days.C o nclusion: The main microorganism was Escherichia coli, and resistance was primarily found in ex-tended-spectrum beta-lactamase-positive bacteria, allowing us to know the local epidemiology of the microbiological profile and its relationship with cancer patients with febrile neutropenia

Factores de riesgo de bacteriemia en niños con cáncer y neutropenia febril / Risk factors for bacteremia in children with cancer and febrile neutropenia

La bacteriemia representa una importante causa de morbimortalidad en pacientes oncológicos. Durante el episodio de neutropenia inducida por quimioterapia, un 15%­25% de los pacientes tendrá bacteriemia. Objetivo: identificar factores de riesgo asociados con bacteriemia en pacientes oncológicos pediátricos con neutropenia y fiebre. Material y métodos: estudio de cohorte prospectivo. Se incluyeron pacientes con enfermedades hematooncológicas y neutropenia febril, internados en un hospital pediátrico de alta complejidad entre julio de 2018 y mayo de 2019. Se excluyeron receptores de trasplante de médula ósea. Se compararon las características clínicas según se documentara bacteriemia (B) o no. Resultados: Se incluyeron 160 pacientes (p). Eran varones 93 (58%). La mediana de edad fue 81,5 meses (RIC 36-127,5). La enfermedad de base (EB) más frecuente fue: leucemia linfoblástica aguda (LLA) 88 (55%). Se identificaron 20 (12,5%) pacientes con bacteriemia (B). En el análisis univariado hubo asociación entre B y LMA (p=0,003) y la internación en UCI (p=0,0001). En el modelo multivariado, ajustado por el resto de las variables, se identificaron la LMA (OR 8,24, IC95% 2,5-26,4; p<0,001) y la tiflitis (OR 5,86, IC95% 1,2-27,3; p=0,02) como factores relacionados con bacteriemia. Los principales microorganismos identificados fueron: estreptococos del grupo viridans 6 (30%), Escherichia coli 4 (20%) y estafilococos coagulasa negativos 3 (15%). Quince (75%) fueron bacteriemias secundarias a un foco clínico. El foco más frecuente fue el mucocutáneo (n=7, 35%). En esta cohorte de niños con cáncer y neutropenia febril, los factores asociados con bacteriemia fueron: la LMA, la tiflitis y la internación en UCI (AU)

Bacteremia is an important cause of morbidity and mortality in oncology patients. During an episode of chemotherapy-induced neutropenia, 15%-25% of patients will develop bacteremia. Objective: to identify risk factors associated with bacteremia in pediatric oncology patients with neutropenia and fever. Material and methods: prospective cohort study. Patients with hematology-oncology diseases and febrile neutropenia, admitted to a tertiary-care pediatric hospital between July 2018 and May 2019 were included. Bone marrow transplant recipients were excluded. Clinical characteristics were compared according to whether or not bacteremia was recorded. Results: 160 patients were included of whom 93 (58%) were male. Median age was 81.5 months (IQR 36-127.5). The most common underlying disease was acute lymphoblastic leukemia (ALL) in 88 patients (55%). Twenty (12.5%) patients with bacteremia were identified. In univariate analysis, an association was found between bacteremia and acute myeloid leukemia (AML) (p=0.003) and ICU admission (p=0.0001). In the multivariate model, adjusted for the remaining variables, AML (OR 8.24; 95%CI 2.5-26.4; p<0.001) and typhlitis (OR 5.86; 95%CI 1.2-27.3; p=0.02) were identified as factors related to bacteremia. The main microorganisms identified were viridans group streptococci in 6 (30%), Escherichia coli in 4 (20%), and coagulase negative staphylococci in 3 (15%). In 15 cases (75%), bacteremia was secondary to a clinical focus. The most frequent focus was mucocutaneous (n=7, 35%). In this cohort of children with cancer and febrile neutropenia, the factors associated with bacteremia were AML, typhlitis, and ICU admission (AU)

Cuidados no uso do dispositivo Pegfilgrastim On-body injector na profilaxia de neutropenia induzida por quimioterapia: revisão de escopo / Cautions in the use of the Pegfilgrastim On-body injector device in the prophylaxis of chemotherapy-induced neutropenia: a scoping review

Introdução: A neutropenia febril induzida por quimioterapia é um fator de risco predisponente para infecção grave e aumenta a mortalidade do paciente com câncer. O uso de G-CSF é recomendado quando o risco de desenvolver neutropenia febril, decorrente do protocolo quimioterápico, é maior ou igual a 20%. Foi recentemente aprovado pela ANVISA uma nova apresentação de G-CSF, o Pegfilgrastim OBI. Dispositivo que conta com um sistema de aplicação automático que é ativado 27 horas após o término da quimioterapia. Objetivo: Mapear os cuidados em saúde para o uso do dispositivo "Pegfilgrastim OBI", na prevenção de neutropenia em pacientes adultos com câncer em assistência domiciliar após quimioterapia ambulatorial. Métodos: A revisão de escopo foi conduzida de acordo com a metodologia da Joanna Briggs Institute. A questão norteadora foi formulada a partir da estratégia PCC. Foram incluídos estudos com pacientes adultos com câncer submetidos à quimioterapia ambulatorial e excluídos estudos com pacientes internados. O protocolo da revisão de escopo foi registrado na organização Open Science Framework. A estratégia de busca foi desenvolvida a partir de descritores controlados e não controlados e foi realizada em 03 de junho de 2022 nas seguintes bases de dados: CENTRAL, CINAHL, EMBASE, LILACS, PubMed, Scopus, LIVIVO e Web of Science. A busca também foi realizada na literatura cinzenta, incluindo Google Scholar, Open Grey, bula do medicamento e websites. Todos os estudos identificados nas bases de dados foram exportados para o gerenciador de referências bibliográficas (EndNote Desktop) para remoção das duplicadas e importados para o aplicativo web Rayyan para realização da seleção das fontes de evidências por pares e às cegas. Resultados: A busca nas bases de dados resultou em 301 artigos que após o processo de seleção resultaram em 11 artigos incluídos. Os resultados foram subdivididos em 4 categorias: adesão do paciente, opinião da equipe de saúde, carga de trabalho do paciente em tratamento oncológico e o uso do dispositivo na prática clínica. O dispositivo apresenta poucas falhas e é aceito pela equipe de saúde e pacientes na maioria dos estudos. O principal benefício do uso do Pegfilgrastim OBI foi o paciente não precisar retornar na clínica no dia seguinte. Já a segunda parte dos resultados foi proveniente das buscas em sites, bulas e manuais e os dados foram exibidos por meio de dois mapas conceituais detalhados. O primeiro mapa conceitual resumiu as informações ao paciente em uso de PegFilgrastim OBI, descrevendo sobre o que é o dispositivo, como é colocado na clínica, os cuidados que o paciente precisa ter em casa e como é realizado a retirada e descarte após aplicação. Já o segundo mapa conceitual resumiu os cuidados que a equipe de enfermagem precisa ter na aplicação e contém informações de como avaliar o local de aplicação, como preparar o dispositivo, etapas da aplicação e o monitoramento do paciente em casa. Conclusão: Compreender os cuidados em saúde no uso do dispositivo Pegfilgrastim OBI otimiza o trabalho da equipe de saúde, favorece melhorias na prática clínica e inclui o paciente com câncer no centro do cuidado

Introduction: Chemotherapy-induced febrile neutropenia is a predisposing risk factor for severe incidence and increased cancer patient mortality. The use of G-CSF is recommended when the risk of developing febrile neutropenia, resulting from the chemotherapy protocol, is greater than or equal to 20%. A new presentation of G-CSF, Pegfilgrastim OBI, was recently approved by ANVISA. Device that has an automatic application system that is activated 27 hours after the end of chemotherapy. Objective: Mapping health care for the use of the "Pegfilgrastim OBI" device in the prevention of neutropenia in adult cancer patients receiving home care after outpatient chemotherapy. Methods: The scoping review was conducted according to the Joanna Briggs Institute methodology. The guiding question was formulated from the PCC strategy. Studies with adult cancer patients undergoing outpatient chemotherapy were included and studies with inpatients were excluded. The scope review protocol was registered with the Open Science Framework organization. The search strategy was developed from controlled and uncontrolled descriptors and was performed on June 3, 2022 in the following databases: CENTRAL, CINAHL, EMBASE, LILACS, PubMed, Scopus, LIVIVO and Web of Science. The search was also performed in the gray literature, including Google Scholar, Open Grey, drug leaflet and websites. All studies identified in the databases were exported to the bibliographic reference manager (EndNote Desktop) to remove duplicates and imported into the Rayyan web application to carry out the selection of evidence sources by peers and blindly. Results: The search in the databases resulted in 301 articles which, after the selection process, resulted in 11 articles included. The results were subdivided into 4 categories: patient adherence, opinion of the health team, workload of the patient undergoing cancer treatment and the use of the device in clinical practice. The device has few flaws and is accepted by the healthcare team and patients in most studies. The main benefit of using Pegfilgrastim OBI was that the patient did not have to return to the clinic the next day. The second part of the results came from searches on websites, package inserts and manuals and the data were displayed through two detailed concept maps. The first concept map summarized the information for the patient using PegFilgrastim OBI, describing what the device is about, how it is placed in the clinic, the care that the patient needs to have at home and how the removal and disposal is performed after application. The second conceptual map summarized the care that the nursing team needs to take in the application and contains information on how to assess the application site, how to prepare the device, application steps and patient monitoring at home. Conclusion: Understanding health care in the use of the Pegfilgrastim OBI device optimizes the work of the health team, favors improvements in clinical practice and includes the cancer patient at the center of care

Etiología bacteriana y susceptibilidad antibiótica en adultos con leucemias agudas y neutropenia febril con factores de alto riesgo / Bacterial etiology and antibiotic susceptibility in adults with acute leukemias and febrile neutropenia with high-risk factors

Introducción: La neutropenia febril es una complicación que predispone a infecciones bacterianas de etiología diversa y aumenta la mortalidad en los pacientes con leucemia. El objetivo general del presente trabajo determinó la frecuencia de la etiología bacteriana, en los objetivos específicos se cuantificó en porcentaje los tipos de bacterias encontradas, se identificó la susceptibilidad y la resistencia antimicrobiana, además de sus infecciones, se estableció los factores de alto riesgo de mal pronóstico más frecuentes. Métodos: En el presente descriptivo de tipo transversal se revisaron historias clínicas del servicio de oncología clínica del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" Solca_Guayquil. El período estudio fue del 1ro de enero del 2013 al 31 de diciembre del 2014. El cálculo muestral fue probabilístico de 60 casos. Se incluyeron pacientes con leucemia en curso de quimioterapia y que evolucionaron con leucopenia febril, adicionalmente se incluyeron los pacientes con focos infecciosos evidentes y cultivos positivos. Las variables fueron demográficas características clínicas de la leucemia, estudio bacteriológico, tratamiento antibiótico y comorbilidades. Se utiliza estadística descriptiva. Resultados: Ingresaron al estudio 58 pacientes, fueron 30/58 mujeres (51%). La mayoría con edades de 17 a 20 años 15/58 casos (25.9%). 35/58 casos (60%) correspondieron a leucemias linfobásticas y 23/58 casos (40%) a miloides. El foco infeccioso más frecuentemente fue gastrointestinal 18 %(n=27), la piel y tejidos blandos con un 17 %(n=26). Se realizaron 98 cultivos, con el 52% de culti-vos positivos, 25 % BLEE, 4% BLAC. La etiología fue E. Coli 26% aislada de sangre. La sensibilidad fue 100 % amikacina, 100 %, imipenem ,100 meropenem, 100 % tigeciclina, 90 % piperazilina tazobactam, 18 %, cefepime, 50% clindamicina y 50% oxacilina. El máximo tiempo de neutropenia fue 30 días, con una mediana de neutrófilos 230 u/ul, con un promedio de 3 días de fiebre. Los factores de riesgo fueron 17% desnutrición ,15% hepatopatías %, 6% hipertensión y diabetes. Conclusiones: La etiología bacteriana más frecuente fue E. Coli. Existe una sensibilidad antibiótica baja para los gram negativos en todas las cefalosporinas de primera hasta cuarta generación en los antibiogramas del estudio. Hay un perfil de baja resistencia a los antibióticos carbapenémicos junto a amikacina con piperacilina tazobactam. La vancomicina y el linezolid no tienen resistencia bacteriana la presentación etológica para gram positivos, el más prevalente fue el estafilococo aureus meticilino resistente tipo BLAC.

Introduction: Febrile neutropenia is a complication that predisposes to bacterial infections of diverse etiology and increases mortality in patients with leukemia. The general objective of this work determined the frequency of bacterial etiology, in the specific objectives the types of bacteria found were quantified in percentage, susceptibility and antimicrobial resistance were identified, in addition to their infections, factors were established high risk of poor prognosis more frequent. Methods: In this descriptive cross-sectional type, clinical records of the clinical oncology service of the National Oncological Institute "Dr. Juan Tanca Marengo "Solca_Guayquil. The study period was from January 1, 2013 to December 31, 2014. The sample calculation was probabilistic of 60 cases. Patients with leukemia undergoing chemotherapy and who evolved with febrile leukopenia were included, additionally patients with obvious infectious foci and positive cultures were included. The variables were demographic, clinical characteristics of the leukemia, bacteriological study, antibiotic treatment, and comorbidities. Descriptive statistics are used. Results: 58 patients entered the study, 30/58 were women (51%). The majority aged 17 to 20 years 15/58 cases (25.9%). 35/58 cases (60%) corresponded to lymphoblastic leukemias and 23/58 cases (40%) to myloids. The most frequent infectious focus was gastrointestinal 18% (n = 27), skin and soft tissues with 17% (n = 26). 98 cultures were performed, with 52% positive cultures, 25% ESBL, 4% BLAC. The etiology was E. Coli 26% isolated from blood. The sensitivity was 100% amika-cin, 100%, imipenem, 100 meropenem, 100% tigecycline, 90% tazobactam piperazilin, 18%, ce-fepime, 50% clindamycin, and 50% oxacillin. The maximum time of neutropenia was 30 days, with a neutrophil average of 230 u / ul, with an average of 3 days of fever. The risk factors were 17% malnutrition, 15% liver disease, 6% hypertension and diabetes. Conclusions: The most frequent bacterial etiology was E. Coli. There is a low antibiotic sensitivity for gram negatives in all first through fourth generation cephalosporins in the study antibiograms. There is a profile of low resistance to carbapenemic antibiotics together with amikacin with piperacillin tazobactam. Vancomycin and linezolid do not have bacterial resistance in the ethological presentation for gram positives, the most prevalent was methicillin-resistant staphylococcus aureus BLAC type.

Febrile neutropenia management in pediatri onco-hematologic patients: a systematic review / Manejo da neutropenia febril em pacientes pediátricos onco-hematológicos: uma revisão sistemática / Manejo de la neutropenia febril en pacientes pediátricos oncohematológicos: una revisión sistemática

Background and Objectives: cancer cases are gradually increasing, and most treatments still cause several adverse reactions, such as myelosuppression. When neutrophils decline, febrile neutropenia (FN) can be triggered, considered an oncological emergency, leaving patients susceptible to infections. Therefore, it is necessary to determine the best treatment, seeking to reduce the risk of complications. The purpose of this review is to identify, in literature, randomized clinical studies that compare different treatments for FN in pediatric onco-hematological patients. Content: a systematic search was carried out on the PubMed database, for randomized clinical studies, from 2009 to 2019, in English, using "Febrile Neutropenia", "Pediatric", and "Therapeutics" as descriptors. A total of 233 articles were found, seven of which were selected for review. The most described antimicrobial for FN treatment was Piperacillin/Tazobactam (PIP/TAZ) and its use is justified by its spectrum of action to cover the most frequent microorganisms in patients with FN. The possibility of using oral antimicrobials may be an alternative and should be analyzed. The description of the risk classification criteria is essential to guide the therapy, and new tools, such as the stewardship, add safety to patient care. Conclusion: the most used antimicrobial to treat FN was PIP/TAZ, and the establishment of standardized risk classification scores in pediatric onco-hematological patients is essential to guide clinical management in FN treatment.(AU)

Justificativa e objetivos: os casos de câncer estão aumentando gradativamente, e a maioria dos tratamentos ainda causa várias reações adversas, como a mielossupressão. Com o declínio dos neutrófilos, pode-se desencadear a neutropenia febril (NF), considerada uma emergência oncológica, deixando o paciente suscetível a infecções. Portanto, é necessário determinar o melhor tratamento, visando reduzir o risco de complicações. O objetivo desta revisão é identificar, na literatura, estudos clínicos randomizados que comparem diferentes tratamentos para NF em pacientes onco-hematológicos pediátricos. Conteúdo: foi realizada busca sistemática na base de dados PubMed, de estudos clínicos randomizados, no período de 2009 a 2019, na língua inglesa, utilizando como descritores "Febrile Neutropenia", "Pediatric" e "Therapeutics". Foram encontrados 233 artigos, dos quais sete foram selecionados para revisão. O antimicrobiano mais descrito para o tratamento com FN foi Piperacilina / Tazobactam (PIP / TAZ) e seu uso justifica-se por seu espectro de ação para cobrir os microrganismos mais frequentes em pacientes com FN. A possibilidade de uso de antimicrobianos orais pode ser uma alternativa e deve ser analisada. A descrição dos critérios de classificação de risco é essencial para orientar a terapia, e novas ferramentas, como o stewardship, agregam segurança ao atendimento ao paciente. Conclusão: o antimicrobiano mais utilizado para tratar FN foi o PIP / TAZ, e o estabelecimento de escores de classificação de risco padronizados em pacientes onco-hematológicos pediátricos é essencial para orientar o manejo clínico no tratamento de FN.(AU)

Antecedentes y objetivos: los casos de cáncer están aumentando gradualmente y la mayoría de los tratamientos aún causan varias reacciones adversas, como la mielosupresión. Cuando los neutrófilos disminuyen, se puede desencadenar la neutropenia febril (FN), considerada una emergencia oncológica, dejando a los pacientes susceptibles a infecciones. Por tanto, es necesario determinar el mejor tratamiento, buscando reducir el riesgo de complicaciones. El propósito de esta revisión es identificar, en la literatura, estudios clínicos aleatorizados que comparen diferentes tratamientos para la FN en pacientes pediátricos oncohematológicos. Contenido: se realizó una búsqueda sistemática en la base de datos PubMed, de estudios clínicos aleatorizados, de 2009 a 2019, en inglés, utilizando como descriptores "Febrile Neutropenia", "Pediatric" y "Therapeutics". Se encontraron un total de 233 artículos, siete de los cuales fueron seleccionados para revisión. El antimicrobiano más descrito para el tratamiento de FN fue Piperacilina / Tazobactam (PIP / TAZ) y su uso se justifica por su espectro de acción para cubrir los microorganismos más frecuentes en pacientes con FN. La posibilidad de utilizar antimicrobianos orales puede ser una alternativa y debe analizarse. La descripción de los criterios de clasificación de riesgo es fundamental para orientar la terapia, y nuevas herramientas, como la rectoría, añaden seguridad a la atención al paciente. Conclusión: el antimicrobiano más utilizado para tratar la FN fue la PIP / TAZ, y el establecimiento de puntuaciones estandarizadas de clasificación de riesgo en pacientes pediátricos oncohematológicos es fundamental para orientar el manejo clínico en el tratamiento de la FN.(AU)

Mortalidad de Pacientes Oncológicos vinculados a Neutropenia / Mortality of Oncological Patients linked to Neutropenia

Introducción: La neutropenia absoluta se presenta comúnmente en pacientes oncológicos en tratamiento activo de quimioterapia, lo que determina aumento de morbi-mortalidad y en muchos casos el manejo clínico debe realizarse en una Unidad de Cuidados Intensivos (UCI). El objetivo del estudio es reportar la mortalidad y supervivencia de un grupo de pacientes neutropénicos ingresados en una UCI. Métodos: En el área de UCI del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo", Solca-Guayaquil, se realizó una investigación observacional retrospectiva, del período Enero 2015 a diciembre 2016. Se seleccionaron pacientes mayores de 18 años con recuentos de neutrófilos ≤500 células / mm3. Las variables fueron sexo, tipo de cáncer, diagnóstico de ingreso, SOFA, ventilación mecánica, falla Hepática, falla renal, tipo de Diagnóstico Infeccioso, tipos de muestras recabadas de cultivos con resultados positivos, germen aislado y mortalidad.Se utiliza análisis descriptivo, de supervivencia, Regresión de COX y análisis de Kaplan Meier. Resultados: Ingresaron al estudio 99 casos, 50 mujeres (51 %), la edad media de 33.7 ±24 años. Los diagnósticos oncológicos más prevalentes fueron Leucemia Linfoblástica Aguda 39 casos (39.4 %) y Leucemia Mieloide Aguda 11 casos (11.1 %). La mortalidad fue de 58 casos (58.6 %) con una supervivencia de 19.7 ± 4.8 días. La Regresión de COX (OR) para hombres fue de 0.7 (IC 95 0.43 ­ 1.246) P= 0.25. La supervivencia por edad fue mayor en el grupo de 10 a 29 años (37.4± 19.8 días), en el grupo de 50 a 59 años, fue de 4.2 ±1.1 días (P<0.05). No existieron diferencias estadísticas de la supervivencia según el motivo de internación. Conclusión: En el presente estudio la mortalidad reportada en pacientes con neutropenia ingresados a UCI fue del (58.6 %). La supervivencia no está asociada al sexo y la mejor supervivencia está asociada con la menor edad. No existieron diferencias estadísticas de la supervivencia según el motivo de internación.

Introduction: Absolute neutropenia is commonly seen in cancer patients undergoing active chemotherapy treatment, which determines increased morbidity and mortality and in many cases clinical management must be performed in an Intensive Care Unit (ICU). The objective of the study is to report the mortality and survival of a group of neutropenic patients admitted to an ICU. Methods: In the ICU area of the National Oncological Institute "Dr. Juan Tanca Marengo ", Solca-Guayaquil, a retrospective observational research was conducted, from January 2015 to December 2016. Patients older than 18 years were selected with neutrophil counts ≤500 cells / mm3. The variables were sex, cancer type, diagnosis of admission, SOFA, mechanical ventilation, Hepatic failure, renal failure, type of Infectious Diagnosis, types of samples collected from cultures with positive results, isolated germ and mortality. Survival, COX regression and Kaplan Meier analysis were used. Results: 99 cases, 50 women (51%), the mean age of 33.7 ± 24 years entered the study. The most prevalent oncological diagnoses were Acute Lymphoblastic Leukemia 39 cases (39.4%) and Acute Myeloid Leukemia 11 cases (11.1%). Mortality was 58 cases (58.6%) with a survival of 19.7 ± 4.8 days. The COX (OR) Regression for men was 0.7 (IC 95 0.43 - 1.246) P = 0.25. The survival by age was higher in the group of 10 to 29 years (37.4 ± 19.8 days), in the group of 50 to 59 years, it was 4.2 ± 1.1 days (P <0.05). There were no statistical differences in survival according to the reason for hospitalization. Conclusion: In the present study, the mortality reported in patients with neutropenia admitted to the ICU was (58.6%). Survival is not associated with sex and the best survival is associated with younger age. There were no statistical differences in survival according to the reason for hospitalization.

Early discharge of pediatric patients with cancer, fever, and neutropenia with low-risk of systemic infection / Egreso temprano en pacientes pediátricos con cáncer, fiebre y neutropenia con bajo riesgo de infección sistémica

Abstract: Background: Ambulatory therapy in low-risk patients with cancer, fever, and neutropenia seems to be a secure and effective alternative. This study aimed to compare the effectiveness and safety of the antimicrobial treatment in early discharge vs. in-hospital treatment in children with cancer and febrile neutropenia (FN) with low risk of invasive bacterial infection (IBI). Methods: Quasi-experimental design with a historical cohort control group. Children with cancer during an episode of FN and low risk of IBI were included. The control group were inpatient children that received intravenous piperacillin/tazobactam. The experimental group was early discharge patients, who received 48 h of IV treatment and were switched to oral treatment. Outcomes: fever resolution, readmissions, and mortality. Results: Eighty low-risk FN episodes were included; the median age was 6 years old (2.6-11 years), and 43 (54%) were female. Main diagnoses were solid tumors (52 patients) and leukemia or lymphoma (28 patients). Forty-three patients received in-hospital treatment, and 37 were selected for early discharge (31 patients received ciprofloxacin and six received amoxicillin/clavulanate). Two patients were readmitted, one due to a relapse of fever with tumor progression and the other due to epistaxis. Adverse effects occurred in 21.6% of the early discharge group and 12% of the inpatient treatment group (p = 0.04). Conclusions: Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.

Resumen: Introducción: El tratamiento ambulatorio en pacientes con cáncer, fiebre y neutropenia de bajo riesgo parece ser una alternativa segura y efectiva. El objetivo de este trabajo fue comparar la efectividad y la seguridad del tratamiento antimicrobiano en la modalidad de egreso temprano vs. el tratamiento intrahospitalario en niños con cáncer y neutropenia febril (NF), con bajo riesgo de infección bacteriana invasiva (IBI). Métodos: Diseño cuasi-experimental con un grupo control histórico. Se incluyeron niños con cáncer durante un episodio de NF con bajo riesgo de IBI. El grupo control fue constituido por pacientes que recibieron tratamiento hospitalario con piperacilina-tazobactam intravenosa. Los pacientes en el grupo de egreso temprano recibieron 48 horas de tratamiento intravenoso y egresaron con antimicrobianos por vía oral. Desenlaces: resolución de la fiebre, reingreso al hospital y muerte. Resultados: Se incluyeron 80 pacientes con NF de bajo riesgo; la mediana de edad fue de 6 años; 43 pacientes (54%) eran de sexo femenino. Los diagnósticos principales fueron tumores sólidos (52) y leucemia o linfoma (28). Cuarenta y tres pacientes recibieron tratamiento hospitalario y 37 fueron seleccionados para egreso temprano. En el grupo de egreso temprano, 31 pacientes recibieron ciprofloxacino y 6 recibieron amoxicilina-clavulanato. Dos pacientes reingresaron, uno por fiebre secundaria a progresión tumoral y otro por epistaxis. Los efectos adversos se presentaron en el 21.6% de los pacientes en el grupo de egreso temprano y en el 12% del grupo de tratamiento hospitalario (p = 0.04). Conclusiones: El egreso temprano para niños con cáncer y NF de bajo riesgo es una alternativa aceptable y segura.

Cervicofacial necrotizing fasciitis of odontogenic origin following chemotherapy: a case report and implications for oral care in cancer treatment

Objective: Cervicofacial necrotizing fasciitis (CNF) is a rapidly spreading and often fatal infection of the soft tissues of head and neck characterized by tissue necrosis and profuse purulent discharge. This report describes a cancer patient, who had undergone chemotherapy and developed CNF of odontogenic origin to highlight the need for oral examination before commencement ofchemotherapy.Case description: A 68 years old retired gardener who developed CNF from infected right permanent mandibular first and second molars. He had undergone surgery and had 3 cycles of Cisplatin, 5-Fluorouracil and Adriamycin on account of carcinoma of the head of pancreas. No oral assessment was carried out prior to commencement of chemotherapy to detect a potential source of infection. Management included removal of the causative teeth, incision and drainage, repeated debridement, daily dressing of wound with Povidone-iodine solution and intravenous antibiotic based on pus microscopy, culture and sensitivity report. He however succumbed to the disease 23 days later. Conclusion: CNF of odontogenic origin is an extremely fatal condition. Early detection and prompt aggressive treatment is a key to successful outcome. Clinicians involved with management of cancer patients should routinely seek the expertise of a dentist for a pre-chemotherapy oral assessment and all potential sources of infections are removed before chemotherapy begins

Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias / Febrile neutropenia in cancer patients: management in the emergency room

Resumen La neutropenia febril es una condición que puede amenazar la vida y que requiere de atención inmediata, particularmente en pacientes en que la misma está asociada a tratamientos con quimioterapia. Estos pacientes tienen un riesgo mucho mayor de desarrollar enfermedades bacterianas, y en ellos, la fiebre puede ser el único indicador de enfermedad bacteriana grave. El manejo adecuado de la neutropenia febril da énfasis en la identificación pronta de los pacientes, estratificación del riesgo y antibioterapia iniciada durante los primeros 60 min del ingreso al servicio de emergencias. No todos los niños con neutropenia febril conllevan el mismo riesgo de morbi-mortalidad, por lo que en los últimos años se han hecho esfuerzos para distinguir entre pacientes de alto riesgo en quienes se recomienda el manejo hospitalario más agresivo. En pacientes que se clasifican como de bajo riesgo se puede considerar el manejo ambulatorio inicial o después de 72 h, mientras que en aquellos de alto riesgo se recomienda hospitalizar y manejar con antimicrobianos parenterales.

Febrile neutropenia is a life-threatening condition that requires immediate attention, especially in patients with chemotherapy-related neutropenia. Patients with febrile neutropenia have a much greater risk of developing bacterial disease, and fever may be the only indicator of severe bacterial infection. Adequate management of febrile neutropenia emphasizes early recognition of patients, risk stratification, and antibiotic therapy administration during the first 60 minutes of admission to an emergency room. Not all children with febrile neutropenia carry the same risk of morbidity and mortality, so in recent years, efforts have been made to distinguish between high-risk patients where more aggressive hospital management is required. In children classified as low-risk, outpatient management may be considered initially or after 72 hours, whilst high-risk patients should be hospitalized and managed with parenteral antibiotics.

The safety and clinical efficacy of recombinant human granulocyte colony stimulating factor injection for colon cancer patients undergoing chemotherapy

Summary Objective: The present study was designed to evaluate safety and efficacy of recombinant human granulocyte colony stimulating factor (G-CSF) injection and whether this regimen could reduce the incidence of adverse events caused by chemotherapy. Method: A total of 100 patients with colon cancer who were treated with chemotherapy in our hospital from January 2011 to December 2014 were randomly divided into two groups, with 50 patients in each group. The patients in the treatment group received G-CSF 24 hours after chemotherapy for consecutive three days; the patients in the control group received the same dose of normal saline. Routine blood tests were performed 7 days and 14 days after chemotherapy. Results: Compared with the control group, the incidences of febrile neutropenia and leukocytopenia in the treatment group were significantly lower (p<0.05). In addition, the incidence of liver dysfunction in the treatment group was lower than that of the control group, without statistical significance. The incidence of myalgia in the treatment was higher than that of the control group without statistical significance. Conclusion: The present study indicated that G-CSF injection after chemotherapy is safe and effective for preventing adverse events in colon cancer patients with chemotherapy.

Neutropenia inducida por citostáticos en oncología / Neutropenia induced by cytostatics in oncology

Se realizó un estudio descriptivo y transversal de 330 pacientes con cáncer, atendidos en el Hospital Oncológico Conrado Benítez de Santiago de Cuba, desde junio hasta diciembre del 2014, para determinar la presencia de neutropenias inducidas por quimioterapia. Presentaron esa afección 145 pacientes (44,0 por ciento). Predominaron el grupo etario de 41-60 años (51,0 por ciento), el sexo femenino (87,5 por ciento), el cáncer de mama (64,8 por ciento), el estadio clínico II (50,3 por ciento), los afectados con 2 episodios de neutropenia (62,1 por ciento), así como los grados leve (51,7 por ciento) y moderado (37,9 por ciento). Respondieron al tratamiento con ior® LeukoCIM 118 pacientes (81,4 por ciento). No se estableció asociación entre las diferentes combinaciones de citostáticos, el número de episodios y los grados de esa enfermedad. La disponibilidad del ior® LeukoCIM para tratar dicha afección facilitará su uso profiláctico y mejorará la calidad de vida de estos pacientes

A descriptive and cross-sectional study of 330 patients with cancer, assisted in Conrado Benítez Oncological Hospital in Santiago de Cuba, was carried out from June to December, 2014, to determine the presence of neutropenias induced by chemotherapy. This disorder was present in 145 patients (44.0 percent). There was a prevalence of the 41-60 age group (51.0 percent), female sex (87.5 percent), breast cancer (64.8 percent), clinical stage II (50.3 percent), those affected patients with 2 neutropenia episodes (62.1 percent), as well as light (51.7 percent) and moderate grades (37.9 percent). One hundred eighteen patients responded to the treatment with ior® LeukoCIM (81.4 percent). There was no association between the different combinations of cytostatics, number of episodes and grades of that disease. The availability of the ior® LeukoCIM to treat this disorder will facilitate its prophylactic use and will improve these patients life quality

Mucormicosis rinosinusal por mucor hiemalis en una paciente con leucemia mieloide aguda / Rhinosinusal mucormycosis by mucor hiemalis in a patient with acute myeloid leukemia

Se reporta un caso clínico de una paciente femenina de 41 años, con antecedentes de leucemia mieloide aguda (LMA) en remisión. Estudiada por hematología, se confirmó recaída de LMA M4. Se inició quimioterapia. La paciente evolucionó con pancitopenia severa. Presentó dos episodios de neutropenia febril, el primero fue asociado a un absceso glúteo que se trató con antibacterianos, y el segundo a compromiso rinosinusal y úlcera necrótica de punta nasal, columela, tabique, cornete inferior izquierdo y paladar duro. Debido a la clínica e imá- genes radiológicas, se sospechó mucormicosis, por lo que se realizó cirugía con debridación extensa y se inició tratamiento antimicótico con anfotericina B desoxicolato. El cultivo de tejido informó abundante desarrollo de Mucor hiemalis. Se mantuvo pancitopénica durante aproximadamente un mes, siendo diariamente evaluada por un equipo multidisciplinario. Se hicieron varios aseos quirúrgicos, en el último se encontró tejido vital. La paciente completó diez días con anfotericina B desoxicolato y posteriormente se hizo traslape a posaconazol oral. Se realizó mielograma de control que evidenció remisión completa de recaída de LMA. Se dio de alta a su domicilio al día 40 de hospitalización, con hemograma adecuado y tratamiento oral con posaconazol para completar 6 semanas en total.

We report a case of a 41-years-old female patient with a history of acute myeloid leukemia (AML) in remission. Hematology studies confirmed relapse of AML M4. Chemotherapy was started. The patient developed severe pancytopenia. She presented two episodes of febrile neutropenia, the first one was associated with a gluteal abscess that was treated with antibacterials, and the second to rhinosinusal involvement and necrotic ulcer of nasal tip, columella, septum, left inferior turbinate and hard palate. Due to clinical and radiological imaging, mucormycosis was suspected, so surgery was performed with extensive debridement and antifungal treatment with amphotericin B deoxicholate was initiated. Tissue culture reported abundant development of Mucor hiemalis. She remained pancytopenic for approximately one month, being evaluated daily by a multidisciplinary team. Several surgical were made, finding vital tissue in the last perform. The patient completed ten days with amphotericin B deoxicholate and later was overlapped to oral posaconazole. A control myelogram was performed, showing complete remission of AML. She was discharged to her home at day 40 of hospitalization, with adequate blood count and oral treatment with posaconazole to complete 6 weeks in total.

Impacto clínico de la profilaxis con levofloxacino en pacientes neutropénicos con neoplasias hematológicas Estudio antes y después, en un hospital de cuarto nivel de Colombia / Clinical impact of levofloxacin prophylaxis in neutropenic patients with hematological malignancies Before and after study in a fourth-level Colombian hospital

Resumen Introducción: el uso de la profilaxis con fluoroquinolonas en pacientes con neutropenia y enfermedades hematológicas malignas es controvertido. Se ha reportado un impacto positivo en la reducción de la morbilidad y mortalidad, pero el consiguiente desarrollo de resistencia bacteriana es una preocupación. Objetivo: comparar la incidencia de neutropenia febril, infección documentada y muerte por infección, en una cohorte de pacientes adultos con neoplasias hematolinfoides en quimioterapia de alto riesgo, que reciben profilaxis con levofloxacino, versus quienes no recibieron profilaxis. Material y métodos: s e realizó un estudio de antes y después. Los desenlaces fueron neutropenia febril, infección clínica y microbiológicamente documentada, duración de la hospitalización, estancia en la unidad de cuidados intensivos, y mortalidad asociada a infección. Resultados: ciento sesenta y ocho (168) admisiones hospitalarias, 98 en el grupo con levofloxacino y 70 en grupo sin profilaxis. El grupo de levofloxacino tuvo reducción de eventos de neutropenia febril (39 vs 70%, p=<0,001), menor tasa de infecciones microbiológicamente documentadas (45.6 vs 61,2%, p= 0.049), menor estancia hospitalaria (24 vs 28.1 días, p=0.008), y menor estancia en la unidad de cuidados intensivos (17 vs 6.1%, p=0.023), comparado con el grupo sin profilaxis. Se encontró asociación en la administración de levofloxacino y reducción de eventos de neutropenia febril OR= 0.21 (IC 95% 0.10-0.43), NNT= 3 (IC 95% 2-6). No se documentó diferencia en la mortalidad (3 vs 8.6%, p=0.118). Conclusiones: la profilaxis mostró beneficio en reducción de eventos febriles, infección micro-biológicamente documentada, menor estancia hospitalaria y en la unidad de cuidados intensivos, sin impacto en la mortalidad. (Acta Med Colomb 2016; 40: 235-242).

Abstract Introduction: the use of fluoroquinolone prophylaxis in patients with neutropenia and hematological malignancies is controversial. A positive impact on reducing morbidity and mortality has been reported, but the subsequent development of bacterial resistance is a concern. Objective: to compare the incidence of febrile neutropenia, documented infection and death from infection in a cohort of adult patients with hematolymphoid neoplasms on high-risk chemotherapy that receive prophylaxis with levofloxacin versus those who did not receive prophylaxis. Material and methods: a before and after study was performed. Outcomes were febrile neutropenia, clinically and microbiologically documented infection, duration of hospitalization, intensive care unit stay, and mortality associated with infection. Results: one hundred sixty-eight (168) hospital admissions, 98 in the levofloxacin group and 70 in the non-prophylaxis group. The levofloxacin group had a reduction in febrile neutropenia events (39 vs 70%, p = <0.001), a lower rate of microbiologically documented infections (45.6 vs 61.2%, p = 0.049), shorter hospital stay (24 vs. 28.1 days , P = 0.008), and shorter stay in the intensive care unit (17 vs 6.1%, p = 0.023) compared to the group without prophylaxis. Association in the administration of levofloxacin and reduction of febrile neutropenia events OR = 0.21 (95% CI 0.10-0.43), NNT = 3 (95% CI 2-6) was found. There was no documented difference in mortality (3 vs 8.6%, p = 0.118). Conclusions: prophylaxis showed benefit in reducing febrile events, microbiologically documented infection, less hospital and intensive care unit stay, with no impact on mortality. (Acta Med Colomb 2016; 40: 235-242).

Impacto clínico de la profilaxis con levofloxacino en pacientes neutropénicos con neoplasias hematológicas / Clinical impact of levofloxacin prophylaxis in neutropenic patients with hematological malignancies

Introducción: el uso de la profilaxis con fluoroquinolonas en pacientes con neutropenia y enfermedades hematológicas malignas es controvertido. Se ha reportado un impacto positivo en la reducción de la morbilidad y mortalidad, pero el consiguiente desarrollo de resistencia bacteriana es una preocupación. Objetivo: comparar la incidencia de neutropenia febril, infección documentada y muerte por infección, en una cohorte de pacientes adultos con neoplasias hematolinfoides en quimioterapia de alto riesgo, que reciben profilaxis con levofloxacino, versus quienes no recibieron profilaxis. Material y métodos: se realizó un estudio de antes y después. Los desenlaces fueron neutropenia febril, infección clínica y microbiológicamente documentada, duración de la hospitalización, estancia en la unidad de cuidados intensivos, y mortalidad asociada a infección. Resultados: ciento sesenta y ocho (168) admisiones hospitalarias, 98 en el grupo con levofloxacino y 70 en grupo sin profilaxis. El grupo de levofloxacino tuvo reducción de eventos de neutropenia febril (39 vs 70%, p=<0,001), menor tasa de infecciones microbiológicamente documentadas (45.6 vs 61,2%, p= 0.049), menor estancia hospitalaria (24 vs 28.1 días, p=0.008), y menor estancia en la unidad de cuidados intensivos (17 vs 6.1%, p=0.023), comparado con el grupo sin profilaxis. Se encontró asociación en la administración de levofloxacino y reducción de eventos de neutropenia febril OR= 0.21 (IC 95% 0.10-0.43), NNT= 3 (IC 95% 2-6). No se documentó diferencia en la mortalidad (3 vs 8.6%, p=0.118). Conclusiones: la profilaxis mostró beneficio en reducción de eventos febriles, infección microbiológicamente documentada, menor estancia hospitalaria y en la unidad de cuidados intensivos, sin impacto en la mortalidad.

Introduction: the use of fluoroquinolone prophylaxis in patients with neutropenia and hematological malignancies is controversial. A positive impact on reducing morbidity and mortality has been reported, but the subsequent development of bacterial resistance is a concern. Objective: to compare the incidence of febrile neutropenia, documented infection and death from infection in a cohort of adult patients with hematolymphoid neoplasms on high-risk chemotherapy that receive prophylaxis with levofloxacin versus those who did not receive prophylaxis. Material and methods: a before and after study was performed. Outcomes were febrile neutropenia, clinically and microbiologically documented infection, duration of hospitalization, intensive care unit stay, and mortality associated with infection.Results: one hundred sixty-eight (168) hospital admissions, 98 in the levofloxacin group and 70 in the non-prophylaxis group. The levofloxacin group had a reduction in febrile neutropenia events (39 vs 70%, p = <0.001), a lower rate of microbiologically documented infections (45.6 vs 61.2%, p = 0.049), shorter hospital stay (24 vs. 28.1 days , P = 0.008), and shorter stay in the intensive care unit (17 vs 6.1%, p = 0.023) compared to the group without prophylaxis. Association in the administration of levofloxacin and reduction of febrile neutropenia events OR = 0.21 (95% CI 0.10-0.43), NNT = 3 (95% CI 2-6) was found. There was no documented difference in mortality (3 vs 8.6%, p = 0.118). Conclusions: prophylaxis showed benefit in reducing febrile events, microbiologically documented infection, less hospital and intensive care unit stay, with no impact on mortality.

Neutropenia febril postquimioterapia, Instituto de Oncología y Radiobiología / Febrile neutropenia after cytostatic therapy observed in the Institute of Oncology and Radiobiology

Objetivo: caracterizar a los pacientes oncológicos que presenten episodios de neutropenia febril postquimioterapia ingresados en el Instituto de Oncología y Radiobiología en el periodo de enero a mayo del 2015. Métodos: se realizó un estudio descriptivo de corte transversal a una muestra de 36 pacientes. Se revisaron las historias clínicas donde se tomaron las variables analizadas. Resultados: predominaron los pacientes del sexo femenino (61,1 por ciento). Dentro de las enfermedades oncológicas predominaron los pacientes con Linfomas no Hodgkin (25,0 por ciento) y los medicamentos citostáticos vinculados a la neutropenia fueron el carboplatino, paclitaxel, ifosfamida y etopósido. La recuperación hematológica se logró en la mayoría de los casos antes de las 72 horas y el mayor número de pacientes (72,2 por ciento) fueron clasificados como una neutropenia de bajo riesgo, según los criterios de la Multinational Association for Supportive Care. Conclusiones: en la muestra estudiada la neutropenia febril presenta un incremento proporcional con la edad y las enfermedades de origen hematopoyéticos, cuyos esquemas quimioterápicos consisten en altas dosis de agentes citostáticos(AU)

Objective: to characterize the oncological patients who present with post chemotherapy febrile neutropenia and were admitted to the Institute of Oncology and Radiobiology in the period of January to May, 2015. Methods: a descriptive cross-sectional study of a sample of 36 patients. Their medical histories were checked from which the analyzed variables were taken. Results: females predominated in the study (61,1 percent). Among the oncological diseases, non-Hodgkin lymphomas (25,0 percent) prevailed whereas the cytostatic drugs found related to neutropenia were carboplatin, paclitaxel, ifosfamide and etoposide. The hematological recovery was reached in most cases before 72 hours and a lot of patients (72, 2 percent) were classified as low risk neutropenia according to the Multinational Association for Supportive Care criteria. Conclusions: in the study sample, the febrile neutropenia increases with the age and with hematopoietic diseases whereas chemotherapy schemes are based on high dose cytostatic agents(AU)

Incidence of Febrile Neutropenia in Korean Female Breast Cancer Patients Receiving Preoperative or Postoperative Doxorubicin/Cyclophosphamide Followed by Docetaxel Chemotherapy / 한국유방암학회지

PURPOSE: Doxorubicin/cyclophosphamide followed by docetaxel chemotherapy (AC-D) is an intermediate risk factor (incidence of 10%–20%) for febrile neutropenia (FN) in breast cancer. However, the reported incidence of FN while using this regimen was obtained mostly from Western breast cancer patients, with little data available from Asian patients. This study aimed to assess the incidence of FN in Korean breast cancer patients and to describe clinical variables related to FN. METHODS: From September 2010 to February 2013, data from the Yonsei Cancer Center registry of breast cancer patients who received neoadjuvant or adjuvant chemotherapy with four cycles of AC-D (60 mg/m2 doxorubicin, 600 mg/m2 cyclophosphamide every 3 weeks for four cycles followed by 75 mg/m2 or 100 mg/m2 docetaxel every 3 weeks for four cycles) were analyzed. The incidence of FN, FN associated complications, dose reduction/delays, and relative dose intensity (RDI) were investigated. RESULTS: Among the 254 patients reported to the registry, the FN incidence after AC-D chemotherapy was 29.5% (75/254), consisting of 25.2% (64/254) events during AC and 4.7% (12/254) during docetaxel chemotherapy. Dose reductions, delays, and RDI less than 85.0% during AC were observed in 16.5% (42/254), 19.5% (47/254), and 11.0% (28/254) of patients, respectively. Patients with FN events frequently experienced dose reduction/delays, which eventually led to a decreased RDI. CONCLUSION: The incidence of FN during AC-D neoadjuvant or adjuvant chemotherapy was higher than expected in Korean breast cancer patients. Whether these patients should be classified as a high-risk group for FN warrants future prospective studies.

Causative Pathogens of Febrile Neutropaenia in Children Treated for Acute Lymphoblastic Leukaemia

<p><b>INTRODUCTION</b>Treatment of acute lymphoblastic leukaemia (ALL) using intensive chemotherapy has resulted in high cure rates but also substantial morbidity. Infective complications represent a significant proportion of treatment-related toxicity. The objective of this study was to describe the microbiological aetiology and clinical outcome of episodes of chemotherapy-induced febrile neutropaenia in a cohort of children treated for ALL at our institution.</p><p><b>MATERIALS AND METHODS</b>Patients with ALL were treated with either the HKSGALL93 or the Malaysia-Singapore (Ma-Spore) 2003 chemotherapy protocols. The records of 197 patients who completed the intensive phase of treatment, defined as the period of treatment from induction, central nervous system (CNS)-directed therapy to reinduction from June 2000 to January 2010 were retrospectively reviewed.</p><p><b>RESULTS</b>There were a total of 587 episodes of febrile neutropaenia in 197 patients, translating to an overall rate of 2.98 episodes per patient. A causative pathogen was isolated in 22.7% of episodes. An equal proportion of Gram-positive bacteria (36.4%) and Gram-negative bacteria (36.4%) were most frequently isolated followed by viral pathogens (17.4%), fungal pathogens (8.4%) and other bacteria (1.2%). Fungal organisms accounted for a higher proportion of clinically severe episodes of febrile neutropaenia requiring admission to the high-dependency or intensive care unit (23.1%). The overall mortality rate from all episodes was 1.5%.</p><p><b>CONCLUSION</b>Febrile neutropaenia continues to be of concern in ALL patients undergoing intensive chemotherapy. The majority of episodes will not have an identifiable causative organism. Gram-positive bacteria and Gram-negative bacteria were the most common causative pathogens identified. With appropriate antimicrobial therapy and supportive management, the overall risk of mortality from febrile neutropaenia is extremely low.</p>

Modelo predictivo de bacteriemia en pacientes neutropénicos febriles / Predictive model of bacteremia in febrile neutropenic patients

La neutropenia febril (NF) es la complicación más frecuente del tratamiento quimioterápico en los pacientes con cáncer. Es considerada una emergencia médica. La atención de los enfermos debe ser pronta y conveniente para contribuir a la disminución de la mortalidad. Como objetivos se propuso: 1) identificar distintos grupos de pacientes según factores de riesgo y la enfermedad neoplásica; 2) conocer la microbiología local de las infecciones; 3) relacionar los diferentes citostáticos con la evolución de los episodios; 4) elaborar un modelo predictivo de riesgo de bacteriemia; 5) sistematizar el tratamiento antimicrobiano empírico; 6) desarrollar una pauta de manejo inicial regionalizada. El trabajo se realizó en el Instituto Oncológico Universitario del Hospital Nacional de Clínicas de Córdoba. Se incluyeron los pacientes con diagnóstico de NF secundaria a quimioterapia y enfermedades neoplásicas y que fueran internados. Criterios de inclusión: recuento de neutrófilos en sangre circulante <0,5 x 109/L ó <1,0 x 109/L con predicción de descenso a <0,5 x 109/L en las siguientes 24 horas y con temperatura axilar > a 38 °C. Se los dividió en un grupo retrospectivo (140 pacientes, desde 01/01/00 al 31/12/08) y otro prospectivo (36 pacientes, desde 01/01/09 al 31/12/10). Los datos disponibles fueron organizados en una planilla de cálculo Excel y luego procesados con el software SPSS 17. En una primera etapa, se realizó un análisis descriptivo univariado, completado con un análisis multivariado utilizando las técnicas de correspondencias múltiples y conglomerados. Para detectar asociaciones entre las variables se usaron pruebas estadísticas de Chi Cuadrado.

SUMMARY: Febrile neutropenia (FN) is the most common complication of chemotherapy in cancer patients. It is considered a medical emergency. The patient must be attended soon and conveniently to decrease the risk of death. The objectives proposed were: 1) identify different groups of patients according to the risk factors and the neoplastic disease; (2) know the local microbiology of infections; (3) link the cytostatics to the episodes evolution; (4) develop a predictive model of risk related to bacteremia; (5) systematize the empirical antimicrobial treatment; (6) develop a regionalized initial guideline of management. The study was conducted in the University Cancer Institute of the National Hospital of Clinics in Córdoba (Argentina). It included patients with diagnosis of NF secondary to chemotherapy and neoplastic diseases. Inclusioncriteria: neutrophil count in peripheral blood <0,5 x 109/L o <1,0 x 109/L with prediction of descent to <0,5 x 109/L in the next 24 hours and axillary temperature > 38 °C. They were divided into a retrospective group (140 patients, from 01/01/00 to 31/12/08) and a prospective one (36 patients, from 01/01/09 to 31/12/10). Available data were organized in a form of Excel spreadsheets and then processed with the software SPSS 17. .