Outpatient versus inpatient IV antibiotic management for pediatric oncology patients with low risk febrile neutropenia: A randomised trial

2014 ◽  
Vol 61 (8) ◽  
pp. 1427-1433 ◽  
Author(s):  
Lisa M. Orme ◽  
Franz E. Babl ◽  
Chris Barnes ◽  
Peter Barnett ◽  
Susan Donath ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Randomised Trial ◽  
Low Risk ◽  
Oncology Patients ◽  
Antibiotic Management

IL-8 Predicts Pediatric Oncology Patients With Febrile Neutropenia at Low Risk for Bacteremia

2013 ◽  
Vol 35 (3) ◽  
pp. 206-211 ◽  
Author(s):  
Carrye R. Cost ◽  
Martha M. Stegner ◽  
David Leonard ◽  
Patrick Leavey
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Low Risk ◽  
Oncology Patients

New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients

2007 ◽  
Vol 83 (7) ◽  
pp. 54-63 ◽  
Author(s):  
Ana Verena Almeida Mendes ◽  
Roberto Sapolnik ◽  
Núbia Mendonça
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Clinical Management ◽  
Oncology Patients ◽  
New Guidelines

#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Miguel A Minero ◽  
Asia Castro ◽  
Martha Avilés-Robles
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

Mannose-binding lectin (MBL) and the risk for febrile neutropenia and infection in pediatric oncology patients with chemotherapy

2010 ◽  
Vol 57 (1) ◽  
pp. 89-96 ◽  
Author(s):  
F.N.J. Frakking ◽  
J. Israëls ◽  
L.C.M. Kremer ◽  
T.W. Kuijpers ◽  
H.N. Caron ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Mannose Binding Lectin ◽  
Oncology Patients ◽  
Mannose Binding ◽  
Binding Lectin

Outpatient management of pediatric oncology patients with low-risk fever and neutropenia: Implementation of new clinical practice guideline at Texas Children's Hospital.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 26-26
Author(s):  
Abhishek Amar Bavle ◽  
Amanda Bell Grimes ◽  
Sibo Zhao ◽  
Daniel Joseph Zinn ◽  
Andrea Jackson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pediatric Oncology ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Outpatient Care ◽  
Blood Cultures ◽  
Low Risk ◽  
Outpatient Management ◽  
Oncology Patients

26 Background: Traditionally, pediatric oncology patients with fever and severe neutropenia (absolute neutrophil count [ANC] <500) are admitted on empiric intravenous (IV) antibiotics pending blood cultures, fever resolution, and a rising ANC. Based on significant evidence that risk-stratification of these patients with fever and neutropenia (FN) and outpatient management of “low-risk” FN (LRFN) patients with oral antibiotics can be safe and effective, we implemented an institutional clinical practice guideline (CPG) to provide outpatient care for children with LRFN. Methods: A validated “Alexander” clinical decision rule was adopted to risk stratify pediatric oncology patients with FN. A new CPG was formulated for the outpatient management of LRFN patients, with either discharge on presentation or at 24-48 hours after admission, with levofloxacin and close follow-up. All stakeholders were educated regarding the new guidelines and process prior to implementation, and the guidelines were approved by the institutional Evidence Based Outcomes Center. Results: In 9 months since guideline implementation, 10/11 (91%) of the eligible patients have been managed outpatient for LRFN (mean ANC 160, range 0 - 480). Seven patients were discharged home from the ER or oncology clinic. Three patients were discharged early at 24 – 48 hours after admission. Outpatient management was safe, and all but one patient had resolution of fever within 48 hours and negative blood cultures. One patient had a positive blood culture with Staphylococcus epidermidis and was admitted for IV antibiotics with no complications. Parents of 9/10 patients responded to surveys. All 9 families found outpatient management to be a good experience, follow-up easy, and reported no adverse effects with levofloxacin. One family preferred inpatient care due to anxiety, while importantly 8/9 (89%) parents said they preferred outpatient care compared to inpatient observation. Conclusions: Pediatric oncology patients with low-risk fever and neutropenia were successfully idenitified and managed in the outpatient setting without adverse events with a high level of parent satisfaction.

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