Hora Dorada de neutropenia febril en cáncer pediátrico Hospital de Niños "J. M. de los Ríos"

Tratamientos intensificados se asocian con neutropenia severa, identificada como factor de riesgo de complicaciones infecciosas en pacientes con enfermedades neoplásicas. Objetivo: Evaluar la importancia del momento de inicio del tratamiento antibiótico en la evolución y pronóstico de pacientes con neutropenia febril (NF) por Cáncer ingresados al Hospital de Niños "J.M. de los Ríos" entre febrero 2020 ­ febrero 2022. Métodos: Estudio descriptivo, prospectivo, transversal, analítico, se registró formulario de recolección de datos y base de datos Google Drive para análisis estadístico por distribución de frecuencias y porcentajes. Se entregó Consentimiento y Asentimiento Informado a padres y pacientes, ambos aprobados por Comisión de Bioética, capacitándose en manejo de fiebre neutropénica. Incluyó pacientes con fiebre durante la primera hora después de recibir quimioterapia, indicándoseles antibióticos. Resultados: Sexo masculino 63,2 % (36/57) de los casos de NF y preescolares 43,9 % (25/57) fueron los más afectados. Leucemia Linfocítica Aguda fue el cáncer más frecuente 68,4 % (39/57) y Bacteriemia 40,4 % (23/57) la patología infecciosa predominante. Evolucionaron satisfactoriamente en la mayoría de los casos; la Media de la estancia hospitalaria fue 14,56 días, más prolongada en pacientes con Leucemia Linfocítica Aguda en fase de inducción. Gramnegativos los aislamientos predominantes 35,1 % (20/57), representados por Pseudomonas aeruginosa. El tiempo de cumplimiento de antibióticos fue 4 - 12 horas desde el inicio de fiebre. Mortalidad ocurrió por enfermedad de base mal controlada. Conclusiones: Cumplimiento de antibióticos durante la primera hora de fiebre neutropénica en pacientes pediátricos con cáncer disminuye complicaciones infecciosas, estancia hospitalaria y mortalidad.

Intensified treatments are associated with severe neutropenia, identified as a risk factor for infectious complications in patients with neoplastic diseases. Objective: To evaluate the importance of the moment of initiation of antibiotic treatment in the evolution and prognosis of patients with febrile neutropenia (NF) due to Cancer admitted to the Hospital de Niños J.M. de los Ríos between February 2020 - February 2022. Methods: Descriptive, prospective, cross-sectional, analytical study, a data collection form and Google Drive database were registered for statistical analysis by distribution of frequencies and percentages. Consent and Informed Assent were given to parents and patients, both approved by the Bioethics Commission, training in the management of neutropenic fever. It included patients with fever during the first hour after receiving chemotherapy, indicating antibiotics. Results: Male sex 63.2 % (36/57) of the cases of NF and preschoolers 43.9 % (25/57) were the most affected. Acute Lymphocytic Leukemia was the most frequent cancer 68.4 % (39/57) and Bacteremia 40.4 % (23/57) the predominant infectious pathology. They evolved satisfactorily in most cases; Mean hospital stay was 14.56 days, longer in patients with Acute Lymphocytic Leukemia in the induction phase. Gram-negative the predominant isolates 35.1 % (20/57), represented by Pseudomonas aeruginosa. Antibiotic compliance time was 4 - 12 hours from the onset of fever. Mortality occurred due to poorly controlled underlying disease. Conclusions: Antibiotic compliance during the first hour of neutropenic fever in pediatric patients with cancer reduces infectious complications, hospital stay and mortality.

Clinical Characteristics of Bacteremia in Children with Cancer / 소아감염

PURPOSE: Bacteremia is one of the most common causes of morbidity and mortality in children with cancer. The aim of this study was to evaluate the clinical features of bacteremia in pediatric cancer patients. METHODS: We retrospectively analyzed bacteremia episodes occurred in pediatric cancer patients at Samsung Medical Center from January 2008 to December 2010. We excluded bacteremia episodes after hematopoietic stem cell transplantation. RESULTS: A total of 141 blood cultures were positive in 121 patients. Thirteen cultures due to contamination were excluded. For analysis, 128 bacteremia episodes in 108 children were included. Gram-positive organisms accounted for 46.9% (60/128) and gram-negative organisms for 53.1% (68/128). The source of bacteremia was identified in 21.1% of episodes. Bacteremia due to catheter related infection was observed in 9.4% of episodes (12/128 episodes) and gram-positive organisms were isolated in 75% of episodes (9/12). There were 10 cases (7.8%) of bacteremia associated with septic shock and gram-negative organisms were isolated in 80% of episodes (8/10). Relapses were documented within 30 days in 2 patients who cleared bacteremia which was confirmed after negative blood cultures. Mortality associated with bacteremia was not observed. CONCLUSION: Continuous monitoring is needed to maintain the tailored strategies to manage pediatric cancer patients with neutropenic fever who are at high risk of developing bacteremia in each institution.

Clinical Aspects and Prognostic Factors of Neutropenic Fever in Leukemic Patients: 1996~2001 / 감염

BACKGROUND: Cancer therapy-related infections due to neutropenia is a well known problem in cancer treatment. Leukemia increases the risk furthermore because of its nature of bone marrow involvement. Therefore knowledge of the aspects of infections in neutropenic leukemic patients are important in preventing morbidity and mortality. METHODS: This study was conducted by reviewing clinical records of 69 cases of 49 leukemic patients who had neutropenic fever during 1996~2001. Each case was reviewed and analyzed in terms of clinical status & treatment, laboratory results, origins of fever and pathogens (if origin was infectious), final outcome and prognostic factors. RESULTS: Of 69 cases of 49 leukemic patients with neutropenic fever, mortalilty was 29%. Microbiologically defined infection (MDI) was 45% and clinically defined infection (CDI) was 30.4%, which meant a increase in MDIs compared with the previous study. Major focuses of fever were lung, blood and catheter-related, which were similar to those of 1988~1995. The major pathogens were gram negative bacilli (43.2%), followed by gram positive cocci (29.7%), but the proportion of gram positive pathogens had increased. Age, usage of selective gut decontamination and colony-stimulating factors (CSFs), and the presence of bone marrow recovery were related to prognosis by univariate analysis. Multivariate logistic regression analysis revealed that the bone marrow recovery was the only significantly related to patient's outcome, which was the same as the previous study (P<0.001). CONCLUSION: Proportions of pathogens in febrile neutropenic patients were similar with the previous study, but gram positive infections are increasing recently. Bone marrow recovery was the only significant prognostic factor in these patients. And, the benefits of selective gut decontamination or CSF usage is still questionable.

Imipenem-cilastatin versus sulbactam-cefoperazone plus amikacin in the initial treatment of febrile neutropenic cancer patients

The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. In this prospective, randomized study, we compared imipenem-cilastatin and sulbactam-cefoperazone with amikacin in the empiric therapy of febrile neutropenic ( 0.05). No major adverse effects occurred. This study demonstrated that imipenem-cilastatin monotherapy and combination therapy of sulbactam-cefoperazone plus amikacin were equally effective empiric therapy for febrile granulocytopenic cancer patients.

Infections in Patients with Acute Leukemia / 감염

BACKGROUND: Infection is the major life-threatening complication of acute leukemia. For the empirical treat-ment of infections in acute leukemia, monitoring of the patterns and trends of the infectious complications is im-portant. METHODS: We prospectively evaluated the febrile epi-sodes in patients with acute leukemia who were admitted to the Seoul National University Hospital during the period from January 1997 to December 1997. RESULTS: Seventy-eight febrile episodes in 56 patients were evaluated. Seventy percent of the febrile episodes were associated with chemotherapy, and 90% of them occurred during the neutropenic period. Common sites of infections were the gastrointestinal tract, followed by oropharynx, central venous catheter, perianal area, skin and soft tissue, blood stream, lung, paranasal sinus, liver, and urinary tract. Sixty-six percent of microbiologically- documented infections were caused by gram-negative organisms, and 26% by gram-positive organisms. Escheri-chia coli was the most common pathogen, and Staphy-lococcus aureus, Klebsiella pneumoniae, Enterobacter cloacae, Staphylococcus ep idermidis, Streptococcus species were common in decreasing order. Ninety-one percent of the total infections were controlled with antimicrobial therapy. CONCLUSION: The gastrointestinal tract was the most frequent site of infections in acute leukemic patients. Gram-negative organisms were responsible for 66% of the microbiologically documented infections. Ninety-one percent of the infectious complications were controlled with antimicrobial therapy.

Analysis on the Causes of Death After Neutropenic Fever Episodes in Pediatric Cancer Patients / 대한소아혈액종양학회지

BACKGROUND: Despite the development of empiric antibiotics in treatment of neutropenic fever(NF) in pediatric cancer patients, bacterial infection is still the most important cause of death in these patients. In this study the authors analyzed clinical characteristics and tried to find out the possible risk factors of the pediatric cancer patients who succumbed to the documented bacterial infection after episodes of neutropenic fever. METHODS: 17 pediatric cancer patients expired after episodes of neutropenic fever(NF) in the pediatric department of Asan Medical Center from Mar. 1990 to Feb. 1996 were grouped by the results of bacterial culture. 7 cases (Group A) had documented bacterial culture results and 10 cases (Group B) had negative culture results. The clinical characteristics of these two groups were analyzed retrospectively. RESULTS: There were no differences in the types of cancer between the two groups. All the documented bacteria were gram negative organisms and all cultured from the blood. There were no differences between the two groups in the treatment duration, known risk factors of infection before and at the onset of fever, antibiotics administered, and interval from the onset of NF to the administration of antibiotics. The response rate of initial empiric antibiotics was lower in group A(14%) compared to Group B(40%), even though all the cultured organisms except 2 cases in Group A were sensitive to initial empirical antibiotics. Septic shock was the cause of death in 86% of Group A patients, but only in 10% of Group B patients. The other causes of death were progression of cancer, bleeding, hepatic failure, adult respiratory distress syndrome and multiple organ failure, which showed no difference between the 2 groups. The interval from the onset of fever to death was significantly shorter in Group A(6.2+/-2.3 days) compared to Group B(24.9+/-18.6 days). CONCLUSIONS: Bacterial infection is still the most frequent cause of death after NF. Most patients succumbed to the documented bacterial infection showed rapid progression of bacteremia to septic shock despite administration of sensitive antibiotics. The known risk factors of infection before the onset of NF and other treatment factors shows no differences between the two groups in this study. These results suggest that the bacteremia is obvious risk factor of poor outcome after NF episode, and antibiotics alone may be insufficient to prevent the rapid progression of septic shock in these patients.