ABSTRACT
Immunocompromised children and adolescents receiving treatment for cancer have an increased risk for potentially life-threatening infectious complications such as blood stream infections with Gram-positive and Gram-negative pathogens. Therefore, several centers for Pediatric Hematology and Oncology administer antibacterial prophylaxis to these patients to lower morbidity and mortality. Two pediatric specific guidelines on antibacterial prophylaxis were recently published. One of these guidelines was drawn up by an international group of pediatric experts of Europe, North and South America and Australia. The other guideline was prepared by an European group convened at the Eighth European Conference on Infections in Leukaemia (ECIL-8). In this review article, the working groups "Infections" of the Society of Pediatric Oncology and Hematology (GPOH) and "Fever in the neutropenic host" of the German Society for Pediatric Infectious Diseases" (DGPI) summarize the available data from randomized studies, systematic reviews and meta-analyses on antibacterial prophylaxis as well of current data on the emergence of resistance and discuss methodological aspects and the recommendations of the two guidelines.
Subject(s)
Communicable Diseases , Hematology , Neoplasms , Adolescent , Anti-Bacterial Agents/adverse effects , Child , Communicable Diseases/drug therapy , Europe , Humans , Neoplasms/drug therapyABSTRACT
PURPOSE: Investigation of the current practice of diagnostics and treatment in pediatric cancer patients with febrile neutropenia. METHODS: On behalf of the German Society for Pediatric Oncology and Hematology and the German Society for Pediatric Infectious Diseases, an Internet-based survey was conducted in 2016 concerning the management of febrile neutropenia in pediatric oncology centers (POC). This survey accompanied the release of the corresponding German guideline to document current practice before its implementation in clinical practice. RESULTS: In total, 51 POCs participated (response rate 73%; 43 from Germany, and 4 each from Austria and Switzerland). Identified targets for antimicrobial stewardship concerned blood culture diagnostics, documentation of the time to antibiotics, the use of empirical combination therapy, drug monitoring of aminoglycosides, the time to escalation in patients with persisting fever, minimal duration of IV treatment, sequential oral treatment in patients with persisting neutropenia, indication for and choice of empirical antifungal treatment, and the local availability of a pediatric infectious diseases consultation service. CONCLUSION: This survey provides useful information for local antibiotic stewardship teams to improve the current practice referring to the corresponding national and international guidelines.
Subject(s)
Antimicrobial Stewardship , Fever/therapy , Neoplasms/complications , Neutropenia/therapy , Adolescent , Austria , Cancer Care Facilities/statistics & numerical data , Child , Child, Preschool , Fever/complications , Germany , Humans , Infant , Infant, Newborn , Neutropenia/complications , SwitzerlandABSTRACT
Immunocompromised children and adolescents receiving treatment for cancer have a considerably increased risk for infection. Neutropenia is the most important single risk factor for infectious complications, and fever in neutropenia is considered as an emergency. Whereas guidelines for the management of fever in neutropenic adults have been established for decades, specific pediatric guidelines have not been developed until recently. As children differ in many aspects from adults such as in the underlying malignancy or in the availability and dosing of antimicrobial compounds, guidelines for pediatric patients are important. This article reviews similarities and differences between the recently published German interdisciplinary guideline of the German Societies of Pediatric Infectious Diseases and Pediatric Oncology and Hematology and a guideline developed by a panel of international experts for the management of fever in neutropenia in children and adolescents.
Subject(s)
Fever/diagnosis , Fever/therapy , Hematology/standards , Medical Oncology/standards , Neoplasms/complications , Neutropenia/diagnosis , Neutropenia/therapy , Practice Guidelines as Topic/standards , Adolescent , Adult , Child , Hematology/methods , Humans , Medical Oncology/methods , Neoplasms/blood , Neoplasms/drug therapy , Societies, Medical/standardsABSTRACT
El autor condensó en estas páginas las ideas cardinales y los planteos que iba elaborando para una exposición mucho más extensa del asunto, que su muerte prematura dejó en proyecto. Acaso lo más profundo que se ha dicho sobre el hombre se puede leer en este libro, y también lo más alentador
ABSTRACT
El autor condensó en estas páginas las ideas cardinales y los planteos que iba elaborando para una exposición mucho más extensa del asunto, que su muerte prematura dejó en proyecto. Acaso lo más profundo que se ha dicho sobre el hombre se puede leer en este libro, y también lo más alentador
ABSTRACT
El autor dedica esta obra a estudiar la simpatía si bien desde un punto de vista filosófico, pasando también por las ideas psicológicas y sociológicas de principios del 1900
