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Fever neutropenia pediatric cancer

Thomas Lehrnbecher, Paula D Robinson, Brian T Fisher, Elio Castagnola, Andreas H Groll, William J Steinbach, Theoklis E Zaoutis, Zelalem F Negeri, Joseph Beyene, Bob Phillips, Lillian Sung
We systematically reviewed and analyzed the available data for galactomannan (GM), β-D-glucan (BG), and polymerase chain reaction (PCR)-based assays to detect invasive fungal disease (IFD) in patients with pediatric cancer or undergoing hematopoietic stem cell transplantation when used as screening tools during immunosuppression or as diagnostic tests in patients presenting with symptoms such as fever during neutropenia (FN). Of 1532 studies screened, 25 studies reported on GM (n = 19), BG (n = 3), and PCR (n = 11)...
August 27, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Eylem Kiral, Ener Cagri Dinleyici, Ayse Bozkurt-Turhan, Ozcan Bor, Yurdanur Akgun, Necat Akdeniz Akgun
Endocan is an endotelial cell specific molecule; previous studies have shown that serum endocan levels increased in cancer and sepsis and are also related to the severity of sepsis. There are no clinical study about serum endocan levels in children with febrile neutropenia. The aim of this study was to evaluate serum endocan levels in pediatric leukemia patients with febrile neutropenia (n=33) and compare them with children with leukemia without fever (n=33) and also with healthy children (n=24). The median serum endocan level in the first group (children with febrile neutropenia) was statistically significantly higher compared to the leukemic children without febrile neutropenia and also control group (P<0...
March 17, 2016: Hematology Reports
Paula D Robinson, Thomas Lehrnbecher, Robert Phillips, L Lee Dupuis, Lillian Sung
PURPOSE: To describe treatment failure and mortality rates with different antibiotic regimens and different management strategies for empirical treatment of fever and neutropenia (FN) in pediatric patients with cancer and hematopoietic stem-cell transplantation (HSCT) recipients. METHODS: We conducted a systematic review and performed searches of MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials. Studies were included if pediatric patients had cancer or were HSCT recipients and the intervention was related to the management of FN...
June 10, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Emily L Mueller, James Croop, Aaron E Carroll
Fever and neutropenia (FN) is a common precipitant for hospitalization among children with cancer, but hospital utilization trends are not well described. This study describes national trends for hospital discharges for FN among children with cancer for the year 2012, compared with the authors' previous analysis from 2009. Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2012. Pediatric patients with cancer who had a discharge for FN were identified using age ≤19 years, urgent or emergent admit type, nontransferred, and a combination of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for fever and neutropenia...
February 2016: Pediatric Hematology and Oncology
Sapna Kaul, Ernest Kent Korgenski, Jian Ying, Christi F Ng, Rochelle R Smits-Seemann, Richard E Nelson, Seth Andrews, Elizabeth Raetz, Mark Fluchel, Richard Lemons, Anne C Kirchhoff
This retrospective study examined the longitudinal hospital outcomes (costs adjusted for inflation, hospital days, and admissions) associated with the treatment of pediatric, adolescent, and young adult acute lymphoblastic leukemia (ALL). Patients between one and 26 years of age with newly diagnosed ALL, who were treated at Primary Children's Hospital (PCH) in Salt Lake City, Utah were included. Treatment and hospitalization data were retrieved from system-wide cancer registry and enterprise data warehouse...
February 2016: Cancer Medicine
Emily L Mueller, Matthew Hall, Samir S Shah, Keith J August, Mohamed A Radhi, Michelle L Macy
BACKGROUND: Emergency department (ED) utilization by children with cancer is poorly understood. Among children with cancer, we explored reasons for ED visits and factors associated with admission within U.S. children's hospitals. METHODS: A retrospective study of the 2011-2013 Pediatric Health Information System (PHIS) was conducted. Eligible ED visits included those within 365 days from the first inpatient encounter with an International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code for cancer...
May 2016: Pediatric Blood & Cancer
Adam L Green, Joanna Yi, Natalie Bezler, Yana Pikman, Venée N Tubman, Esther A Obeng, Teresa O'Neil, Robert Mersereau, Lisa Morrissey, Amy L Billett
BACKGROUND: Fever and neutropenia (F&N) is a pediatric oncology emergency due to the risk of disseminated infection. Quality improvement (QI) efforts to improve time to antibiotics for F&N in the emergency department have been documented, but the issue has not been studied in the established inpatient setting. PROCEDURE: We undertook a prospective cohort QI study to decrease time to antibiotics for neutropenic pediatric oncology inpatients with new fever to <60 min...
January 2016: Pediatric Blood & Cancer
Emily L Mueller, Kelly J Walkovich, Gregory A Yanik, Sarah J Clark
Considerable variation in the management of fever and neutropenia (FN) exists, with factors associated with treatment variation not well described. An online survey of 90 pediatric cancer providers in Michigan was performed in Spring 2014. The survey frame was pediatric patients with cancer receiving treatment, with a Port-a-cath, who were clinically stable. Criteria for "Decreased" and "Increased" risk groups were defined by respondents. Survey questions addressed FN definitions, risk groups conceptualization, routine clinical practice, and management guidelines, in the context of risk groups and distance to treating institution...
2015: Pediatric Hematology and Oncology
Elham Olad, Iraj Sedighi, Azim Mehrvar, Maryam Tashvighi, Vahid Fallahazad, Amirabbas Hedayatiasl, Hossein Esfahani
OBJECTIVE: Timely detection of serious bacterial infections or prediction of sepsis and death is of paramount importance in neutropenic patients especially in oncology settings. The aim of this study was to determine a rapid and secure predictor of sepsis in severe neutropenic cancer children. METHODS: In addition to blood culture, we have evaluated serum soluble CD14 on this role and measured it in 39 neutropenic episodes in Mahak pediatric oncology center from September 2012 to January 2013...
December 2014: Iranian Journal of Pediatrics
Emily L Mueller, Kelly J Walkovich, Rajen Mody, Achamyeleh Gebremariam, Matthew M Davis
BACKGROUND: Fever and neutropenia (FN) is a common complication of pediatric cancer treatment, but hospital utilization patterns for this condition are not well described. METHODS: Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2009. Pediatric FN patients were identified using: age ≤19 years, urgent or emergent admit type, non-transferred, and a combination of ICD-9-CM codes for fever and neutropenia. Sampling weights were used to permit national inferences...
2015: BMC Cancer
Avani D Rao, Elizabeth A Sugar, Neil Barrett, Mahadevappa Mahesh, Robert J Arceci
Despite the frequent use and radiation exposure of computed tomography (CT) scans, there is little information on patterns of CT use and their utility in the management of pediatric patients with fever and neutropenia (FN). We examined the contribution of either the commonly employed pan-CT (multiple anatomical locations) or targeted CT (single location) scanning to identify possible infectious etiologies in this challenging clinical scenario. Procedure Pediatric patients with an underlying malignancy admitted for fever (temperature ≥ 38...
October 2015: Pediatric Blood & Cancer
Dawn Nolt, Susan Lindemulder, Jeffrey Meyrowitz, Bill H Chang, Suman Malempati, Gregory Thomas, Linda Stork
BACKGROUND: Treatment of acute myeloid leukemia (AML) comes with a significant risk of life-threatening infection during periods of prolonged severe neutropenia. We studied the impact of preventive intravenous (IV) antibiotic administration at onset of absolute neutropenia on the incidence and outcome of life-threatening infections during treatment of childhood AML. PROCEDURES: This is a retrospective study on pediatric patients (aged 0-18 years) consecutively diagnosed with de novo AML and treated at a single institution from April 2005 through February 2013...
July 2015: Pediatric Blood & Cancer
Roland A Ammann, Oliver Teuffel, Philipp Agyeman, Nadine Amport, Kurt Leibundgut
BACKGROUND: The temperature limit defining fever (TLDF) is based on scarce evidence. This study aimed to determine the rate of fever in neutropenia (FN) episodes additionally diagnosed by lower versus standard TLDF. METHODS: In a single center using a high TLDF (39.0°C tympanic temperature, LimitStandard), pediatric patients treated with chemotherapy for cancer were observed prospectively. Results of all temperature measurements and CBCs were recorded. The application of lower TLDFs (LimitLow; range, 37...
2015: PloS One
Jennifer L Salstrom, Rebecca L Coughlin, Kathleen Pool, Melissa Bojan, Camille Mediavilla, William Schwent, Michael Rannie, Dawn Law, Michelle Finnerty, Joanne Hilden
BACKGROUND: Antibiotic delivery to patients with fever and neutropenia (F&N) in <60 min is an increasingly important quality measure for oncology centers, but several published reports indicate that a time to antibiotic delivery (TTA) of <60 min is quite difficult to achieve. Here we report a quality improvement (QI) effort that sought to decrease TTA and assess associated clinical outcomes in pediatric patients with cancer and F&N. PROCEDURE: We used Lean-Methodology and a Plan-Do-Study-Act approach to direct QI efforts and prospectively tracked TTA measures and associated clinical outcomes (length of stay, duration of fever, use of imaging studies to search for occult infection, bacteremia, intensive care unit (ICU) consultation or admission, and mortality)...
May 2015: Pediatric Blood & Cancer
Meret Henry, Lillian Sung
Advancements in the care of children with cancer have, in part, been achieved through improvements in supportive care. Situations that require prompt care can occur at the time of presentation as well as during treatment. This article discusses the approach to children with fever and neutropenia, a complication encountered daily by care providers, as well as oncologic emergencies that can be seen at the time of a child's initial diagnosis: hyperleukocytosis, tumor lysis syndrome, superior vena cava syndrome, and spinal cord compression...
February 2015: Pediatric Clinics of North America
Naima A Al-Mulla, Saad J Taj-Aldeen, Sittana El Shafie, Mohammed Janahi, Abdullah A Al-Nasser, Prem Chandra
PURPOSE: Bloodstream infections in pediatric hematology and oncology represent a major problem worldwide, but this has not been studied in Qatar. In this study, we investigated the burden of infection and the resistance pattern in the bacterial etiology, in the only tertiary pediatric hematology and oncology center in Qatar. METHODS: All pediatric cancer patients (n=185) were evaluated retrospectively during the period 2004-2011; a total of 70 (38%) patients were diagnosed with bloodstream infections...
2014: Infection and Drug Resistance
Emily L Mueller, Amber Sabbatini, Achamyeleh Gebremariam, Rajen Mody, Lillian Sung, Michelle L Macy
BACKGROUND: Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting ED visits and factors associated with hospital admission. PROCEDURE: A retrospective cohort analysis of pediatric ED visits from 2006 to 2010 using the Nationwide Emergency Department Sample, the largest all-payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software...
March 2015: Pediatric Blood & Cancer
Takeo Sarashina, Ryoji Kobayashi, Makoto Yoshida, Naohisa Toriumi, Daisuke Suzuki, Hirozumi Sano, Hiroshi Azuma
BACKGROUND: Febrile neutropenia (FN) is a common and serious complication of cancer chemotherapy associated with significant morbidity and mortality. Cefozopran (CZOP) is a potential candidate for empirical monotherapy in FN. However, studies on the use of CZOP as empirical treatment for pediatric patients with FN are quite limited. The purpose of this study was to compare the efficacy and safety of CZOP with cefepime (CFPM) empirical monotherapy in pediatric cancer patients with FN. PROCEDURES: A total of 64 patients with 224 episodes of FN were randomly assigned to receive antibiotic therapy with either CZOP (100 mg/kg/day) or CFPM (100 mg/kg/day)...
November 2014: Pediatric Blood & Cancer
Siham Cherkaoui, Mouna Lamchahab, Hassoun Samira, Khalid Zerouali, Abdallah Madani, Said Benchekroun, Asmaa Quessar
OBJECTIVE: HAI cause considerable morbidity and mortality and are associated with prolonged hospital stay and increased health care costs. To describe the incidence of HAI in paediatric cancer patients as the first step towards improving infection control policies. METHODS: A prospective surveillance study was performed in the Casablanca university hospital paediatric haematology/oncology unit over an 8-month period from January to August 2011. Data including extrinsic risk factors associated with HAI were recorded...
March 2014: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
Gulay Sezgin, Can Acipayam, Ayse Ozkan, Ibrahim Bayram, Atila Tanyeli
BACKGROUND: Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/ TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer. MATERIALS AND METHODS: Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed...
2014: Asian Pacific Journal of Cancer Prevention: APJCP
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