Neutropenia febril. Análisis de casos en un centro de tercer nivel de atención / Febrile neutropenia. Case analysis in a third level attention center

Introducción: La neutropenia febril es una urgencia infectológica con agentes etiológicos diversos. La causa más frecuente es la postquimioterapia, con una incidencia del 80%en inmunocomprometidos. Requiere el uso de antimicrobianos de amplio espectro, que originan mayores gastos en el sistema de salud. Objetivos: identificar los agentes microbiológicos en pacientes con neutropenia febril internados en el Hospital de la Asociación Médica de Bahía Blanca "Dr.Felipe Glasman" (HAMBB), en el periodo enero-diciembre de 2017; evaluar la sensibilidad y resistencia antimicrobiana; determinar el porcentaje de rédito de los cultivos. Materiales y Métodos: Estudio retrospectivo, descriptivo. Se obtuvieron datos de historias clínicas y de registros informatizados de los pacientes hospitalizados por neutropenia febril. Resultados: Se analizaron 52 episodios de 49 de pacientes. Las patologías de base fueron: tumores sólidos (54%); oncohematológicos (36%); enfermedades no neoplásicas (8%). El episodio febril fue postquimioterapia (48 %): por infección (35%); otras causas (17%). El 31% de los episodios postquimioterapia ocurrieron postratamiento (7-15 días). Los cultivos fueron negativos en el 69%. Se identificaron E.coli (15%); S.aureus (8%), P.aeruginosa (4%); 2% enterobacter (2%); E.faecalis ( 2%). Sensibilidad antibiótica: E.coli sensible a aminoglucósidos y fluoroquinolonas en el 87,5%, con resistencia de 50% para betalactámicos; a betalactámicos+IBL, cefalosporinas de 1° generación y cotrimoxazol (37,5%). S.aureus, E.faecalis, Enterobacter y P. aeruginosa fueron 100% sensibles a los antibióticos testeados. Conclusiones: El mayor porcentaje: bacterias Gram (-); principal agente causal: E. coli; principal agente Gram (+): S. aureus. La mayoría fueron pacientes con tumores sólidos. El 50 % de los episodios fue posterior postquimioterapia. El mayor rédito se obtuvo en hemocultivos. La mayor parte de los gérmenes fueron sensibles a la terapéutica empírica utilizada en nuestro hospital. (AU)

Introduction: Febrile neutropenia is an infectious emergency with diverse etiological agents. The most frequent cause is post-chemotherapy, with an incidence of 80% in immunocompromised patients. It requires the use of broadspectrum antimicrobials, which lead to higher expenses in the health system. Objectives: To identify the microbiological agents in patients with febrile neutropenia admitted to Bahía Blanca Medical Association "Dr. Felipe Glasman " Hospital (HAMBB) in the January-December 2017 period; to evaluate antimicrobial susceptibility and resistance; to determine the percentage of positive cultures. Materials and Methods: Retrospective, descriptive study. Data from medical records and computerized records of patients hospitalized for febrile neutropenia were obtained. Results: 52 episodes from 49 patients were analyzed. Underlying pathologies were: solid tumors (54%); oncohaematological (36%); non-neoplastic diseases (8%). The febrile episode was postchemotherapy (48%); due to infection (35%); other causes (17%). Thirty one per cent (31%) of post-chemotherapy episodes occurred after treatment (7-15 days). Cultures were negative in 69% of the cases. We could identify E.coli (15%); S.aureus (8%), P. aeruginosa (4%); 2% enterobacter (2%); E.faecalis (2%). Antibiotic susceptibility: E.coli sensitive to aminoglycosides and fluoroquinolones in 87.5%, with 50% resistance to betalactams; to beta-lactamases + IBL, 1st generation cephalosporins and cotrimoxazole (37.5%). S.aureus, E.faecalis, Enterobacter and P. aeruginosa were 100% susceptible to the antibiotics tested. Conclusions: The highest percentage: Gram bacteria (-); main causal agent: E. coli; Main agent Gram (+): S. aureus. The majority were patients with solid tumors. 50% of the episodes were post-chemotherapy. The occurrence was obtained in blood cultures. Most germs were susceptible to the empirical therapy used in our hospital. (AU)

Callosotomy in children - Parental experiences reported at long-term follow-up.

Callosotomy is a palliative surgery method for selected individuals with severe, drug-resistant epilepsy. The aim of this retrospective study was to explore parental experiences of the family's life situation before and long after their child had undergone callosotomy. Semistructured interviews of the parents of 12 children were analyzed using a combination of inductive and deductive qualitative content analysis. Before surgery, parents felt that they lived in a chaotic bubble with an unbearable situation; their child had severe and frequent seizures and had to be looked after constantly. Most parents were both satisfied and dissatisfied with the given support and information. However, if the child did not improve after surgery, parents often felt that the information before surgery had not been adequate. After surgery, they found a glimpse of hope. They felt that the family got a new life; the reduced seizure severity led to a better life situation for the family. The support was described as both good and poor. The family life situation was complex, and even if they were partly satisfied with the support, it was still not enough. However, the life situation was also very stressful because of remaining seizures, behavioral problems, and sometimes, adverse effects of surgery. The families lived in disappointment and difficulty and had to fight for their rights. This indicates that these families need more information and social service coordination both before and long after surgery. They need not only tools to manage the child's disabilities but also substantial help to care for the child and to receive the social support they need.

Parental experiences before and long-term after their children's hemispherotomy - A population-based qualitative study.

Severe childhood epilepsy has an impact on the whole family. For selected children, hemispherotomy is the treatment of choice. The aim of this study was to explore parents' experiences before and after hemispherotomy as reported at a long-term follow-up and their view on received information and support. This was a population-based qualitative descriptive study, using qualitative content analysis of interviews. Seven to eighteen years after hemispherotomy, parents of twenty-one operated children were interviewed about the family life situation, expectations before surgery, and support and information before and after surgery. Before surgery, the theme 'Living in a chaotic bubble' illuminates how parents felt: the family lived in isolation, they felt both dissatisfaction and satisfaction about support and information, and they experienced that surgery was a question about life or death. After surgery, the theme 'Hovering between success and disaster' illuminates how parents hovered between happiness if the surgery was successful and sadness about e.g., complications and behavior problems. They experienced both excellent and poor support, in hospital and at rehabilitation. Regardless of all concerns, parents were satisfied that the child had received an operation. The hemispherotomies were successful and generated a better life situation. However, in order to cope, families need support and information throughout the whole process, from the onset of epilepsy and for a long time after surgery. If the child has behavior problems, an assessment should be made before surgery in order for the families to get adequate support. The specialist team needs to be involved as early as possible and follow the families for several years after surgery. Focus should be on the whole family, if needed including grandparents; family-centered care might be relevant for this patient group.

A long-term patient perspective after hemispherotomy--a population based study.

PURPOSE: Explore the long-term life situation for Swedish hemispherotomy patients reporting not only seizure outcome but also patients' perspectives on function, quality of life (QoL) and satisfaction with the surgery. METHODS: This population based study uses prospectively collected data from the Swedish National Epilepsy Surgery Register. An independent researcher interviewed patients or parents, using two patient oriented questionnaires. RESULTS: Twenty-nine patients underwent hemispherotomy in Sweden after 1995 and had a five- or ten-year follow-up. At the 2-year follow-up 55% (16/29) were seizure-free since surgery, and 11/29 (38%) were seizure-free at the long term follow up. Twenty-six (90%) participated in this study. Median time to interview was 13.5 years; 9/26 (35%) were seizure-free then; 23% were off antiepileptic medication. In those not seizure-free, seizures were considered mild or moderate; 11% attended mainstream school and 3/12 adults lived independently. Most parents both of seizure-free and non seizure-free patients reported QoL and general health to be very good/good; 73% were satisfied/very satisfied with the hemispherotomy. CONCLUSION: In this series there were more long-term recurrences than previously reported. This might be related to the lower level of function of this cohort and higher percentage of developmental aetiologies compared to other series. However, most hemispherotomy patients have a good QoL in the long run and feel that the operation was worthwhile, even when it did not stop seizures. The majority had persisting impairments. Proxies were not very concerned about seizures, indicating that reduction in seizure frequency and/or severity may be an important gain with hemispherotomy.