Febrile neutropenic episodes in children with lymphoma and malignant solid tumors

Güneş D., Mutafoǧlu K., Çetinkaya H., Arslan H., Çakir D., Olgun N.

Cocuk Enfeksiyon Dergisi, cilt.4, sa.1, ss.1-8, 2010 (SCI-Expanded) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 4 Sayı: 1
  • Basım Tarihi: 2010
  • Dergi Adı: Cocuk Enfeksiyon Dergisi
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.1-8
  • Anahtar Kelimeler: Cancer, Childhood, Febrile neutropenia
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

Objective: To analyze febrile neutropenic episodes (FNEs) of children with lymphoma and malignant solid tumors (MSTs). Methods: Medical records of children with cancer who had FNEs between July 01, 2005-August 01, 2007 were analyzed. Neutropenia was defined as an absolute neutrophil count (ANC) of <500 cells/mm3 or a count of <1000 cells/ mm3, with a predicted decrease to <500 cells/ mm3 within 24-48 h. Fever was defined as a single axillary temperature ≥38.5°C, or ≥38°C for 1 h, or ≥38°C in two consecutive measurements with at least 4h interval. Results: Seventy-three febrile neutropenic episodes in 33 children were analyzed. The median age of diagnosis was 6 years (5 months-18years), M:F ratio was 2. The diagnosis was lymphoma in 24%, malignant solid tumors (MSTs) in 76%, and 77% of FNEs occurred in patients with MSTs. Patients received prophylactic G-CSF before 78% of the episodes. Clinical and microbiological documentation was available in 55% and 16% of FNEs, respectively. Isolated microorganisms were mostly (85%) gram (-) bacteria. Empirical treatment was monotherapy in 22%, duotherapy in 48%, three antibiotics in 22%, more than three antibiotics in 8%. As empirical therapy, 39 patients received cephalosporins, 34 patients received carbapenems. Antibiotic modification was required in 22%. Overall, glycopeptides, antifungal and antiviral agents were used in 35%, 20% and 5% of FNEs, respectively. Fever was controlled within a median of 48h (1-18 days). Parenteral antibiotics were switched to oral cefixime before 7th day of the treatment in 42% of FNEs. Parenteral antibiotherapy duration was >10days in 14% of FNEs. Shock developed in 5 FNEs. Conclusion: Twenty-two percent of FNEs were treated with monotherapy, and in 42% of episodes, parenteral antibiotics were used for less than one week. The majority of patients were hospitalized for less then 10 days. Neither fever control time, nor antibiotic modification rate was different in the cephalosporin and carbapenem groups.