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Fever and Neutropenia in Children With Cancer

M E Santolaya, A M Alvarez, M Acuña, C L Avilés, C Salgado, J Tordecilla, M Varas, M Venegas, M Villarroel, M Zubieta, A Toso, A Bataszew, M J Farfán, V de la Maza, A Vergara, R Valenzuela, J P Torres
OBJECTIVES: To determine efficacy and safety of withholding antimicrobials in children with cancer, fever and neutropenia (FN) with a demonstrated respiratory viral infection. METHODS: Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials...
March 2017: Clinical Microbiology and Infection
Juan Pablo Torres, Verónica De la Maza, Lisette Kors, Milena Villarroel, Paula Piemonte, Giannina Izquierdo, Carmen Salgado, Juan Tordecilla, Verónica Contardo, Mauricio J Farfán, Asunción Mejías, Octavio Ramilo, María Elena Santolaya
BACKGROUND: Respiratory viral infections in episodes of fever and neutropenia (FN) in children with cancer are not well characterized. We compared the clinical outcome of infections caused by different respiratory viruses (RVs) and by RV coinfection in this population. METHODS: Children with cancer and FN at 3 hospitals in Chile were prospectively evaluated by clinical examination, blood cultures and detection of 17 RVs using multiplex polymerase chain reaction (nasopharyngeal samples)...
September 2016: Pediatric Infectious Disease Journal
Vural Kesik, Erman Ataş, Yasemin Gülcan Kurt, Fevzi Nuri Aydın, Oğuzhan Babacan, Mustafa Gülgün, Nadir Korkmazer
AIM OF STUDY: Neutropenic fever is a source of morbidity and mortality in children with cancer. It is not possible to detect the causative agent in cultures in most cases; the research for a marker that can show the severity of the disease is ongoing. We evaluated the role of adrenomedullin (ADM) at predicting prognosis on patients with febrile neutropenia, which has been proven to be a good prognostic marker for diseases with high morbidity and mortality, such as heart failure, ischemic ventricular dysfunction, sepsis, and systemic inflammatory response syndrome...
September 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
David H Abramson, Brian P Marr, Jasmine H Francis, Ira J Dunkel, Armida W M Fabius, Scott E Brodie, Ijah Mondesire-Crump, Y Pierre Gobin
OBJECTIVE: Report on the 7-year experience with bilateral ophthalmic artery chemosurgery (OAC-Tandem therapy) for bilateral retinoblastoma. DESIGN: Retrospective, single institution study. SUBJECTS: 120 eyes of 60 children with bilateral retinoblastoma treated since March 2008. METHODS: Retrospective review of all children treated at Memorial Sloan Kettering with bilateral ophthalmic artery chemosurgery (Melphalan, Carboplatin, Topotecan, Methotrexate) delivered in the same initial session to both naïve and previously treated eyes...
2016: PloS One
Elvira C van Dalen, Arno Mank, Edith Leclercq, Renée L Mulder, Michelle Davies, Marie José Kersten, Marianne D van de Wetering
BACKGROUND: Neutropenia is a potentially serious side effect of chemotherapy and a major risk factor for infection, which can be life-threatening. It has been hypothesised that a low bacterial diet (LBD) can prevent infection and (infection-related) mortality in cancer patients receiving chemotherapy that causes episodes of neutropenia, but much remains unclear. This review is an update of a previously published Cochrane review. OBJECTIVES: The primary objective of this review was to determine the efficacy of an LBD versus a control diet in preventing infection and in decreasing (infection-related) mortality in adult and paediatric cancer patients receiving chemotherapy that causes episodes of neutropenia...
April 24, 2016: Cochrane Database of Systematic Reviews
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
Robert S Phillips, Lillian Sung, Roland A Amman, Richard D Riley, Elio Castagnola, Gabrielle M Haeusler, Robert Klaassen, Wim J E Tissing, Thomas Lehrnbecher, Julia Chisholm, Hana Hakim, Neil Ranasinghe, Marianne Paesmans, Ian M Hann, Lesley A Stewart
BACKGROUND: Risk-stratified management of fever with neutropenia (FN), allows intensive management of high-risk cases and early discharge of low-risk cases. No single, internationally validated, prediction model of the risk of adverse outcomes exists for children and young people. An individual patient data (IPD) meta-analysis was undertaken to devise one. METHODS: The 'Predicting Infectious Complications in Children with Cancer' (PICNICC) collaboration was formed by parent representatives, international clinical and methodological experts...
March 15, 2016: British Journal of Cancer
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
Jessica E Morgan, Jemma Cleminson, Karl Atkin, Lesley A Stewart, Robert S Phillips
PURPOSE: Reduced intensity therapy for children with low-risk febrile neutropenia may provide benefits to both patients and the health service. We have explored the safety of these regimens and the effect of timing of discharge. METHODS: Multiple electronic databases, conference abstracts and reference lists were searched. Randomised controlled trials (RCT) and prospective observational cohorts examining the location of therapy and/or the route of administration of antibiotics in people younger than 18 years who developed low-risk febrile neutropenia following treatment for cancer were included...
June 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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
Karin G E Miedema, Wim J E Tissing, Floor C H Abbink, Lynne M Ball, Erna M C Michiels, Michel J van Vliet, Wilma Y de Vries, Willem A Kamps, Obbe F Norbruis, Marta Fiocco, Hester A de Groot-Kruseman, Marianne D van de Wetering, Eveline S J M de Bont
BACKGROUND: In this national multicentre study, we examined the safety of reducing antibiotics in selected paediatric cancer patients with febrile neutropenia. METHODS: Patients with signs of a bacterial infection and/or abnormal vital signs indicating sepsis were considered high risk and received antibiotic therapy. Remaining patients were allocated to low- or medium risk, depending on their interleukin-8 level. Low-risk patients did not receive any antibiotics and were discharged from the hospital after having been afebrile for 12 h...
January 2016: European Journal of Cancer
Chen Mao, Xiao-Hong Fu, Jin-Qiu Yuan, Zu-Yao Yang, Ya-Fang Huang, Qian-Ling Ye, Xin-Yin Wu, Xue-Feng Hu, Zhi-Min Zhai, Jin-Ling Tang
BACKGROUND: Acute myeloid leukaemia (AML) is a malignant cancer of hematopoietic stem cells. The treatment of AML consists of two treatment phases: the remission induction phase to achieve a rapid, complete remission (CR) and the consolidation phase to achieve a durable molecular remission. People in CR are at risk of AML relapse, and people with relapsed AML have poor survival prospects. Thus, there is a continuous need for treatments to further improve prognosis. Interleukin-2 (IL-2), an immune-stimulatory cytokine, is an alternative to standard treatment for people with AML to maintain the efficacy after consolidation therapy...
November 6, 2015: Cochrane Database of Systematic Reviews
Mathilde Delebarre, Nathalie Garnier, Emilie Macher, Estelle Thebaud, Françoise Mazingue, Pierre Leblond, Alain Duhamel, Alain Martinot, François Dubos
To distinguish children with chemotherapy-induced febrile neutropenia (FN) at low risk of severe infection, the variables that are significant risk factors must be identified. Our objective was to identify them by applying evidence-based standards. This retrospective 2-center cohort study included all episodes of chemotherapy-induced FN in children in 2005 and 2006. The medical history, clinical, and laboratory data available at admission were collected. Severe infection was defined by bacteremia, a positive culture of a normally sterile body fluid, invasive fungal infection, or localized infection at high risk of extension...
November 2015: Journal of Pediatric Hematology/oncology
Gabrielle M Haeusler, Lillian Sung, Roland A Ammann, Bob Phillips
PURPOSE OF REVIEW: Fever and neutropenia is the most common complication in the treatment of childhood cancer. This review will summarize recent publications that focus on improving the management of this condition as well as those that seek to optimize translational research efforts. RECENT FINDINGS: A number of clinical decision rules are available to assist in the identification of low-risk fever and neutropenia however few have undergone external validation and formal impact analysis...
December 2015: Current Opinion in Infectious Diseases
Metin Demirkaya, Deniz Tugcu, Arzu Akcay, Gönül Aydogan, Ferhan Akıcı, Zafer Salcioglu, Hakan Ekmekci, Betül Sevinir, Ozlem Balci Ekmekci
In this study, we aimed to determine serum adrenomedullin levels and compare them with levels of C-reactive protein (CRP) and procalcitonin (PCT). Cancer patients aged 0-18 years who experienced febrile neutropenia attacks were included in the study. Adrenomedullin, CRP, and PCT were analyzed at admission, day 3, and days 7-10 later. Fifty episodes of febrile neutropenia that developed in 37 patients were analyzed in this study. The mean age of the patients was 7.5 ± 4.7 (1-18) years. The patients had leukemia (73%), solid tumors (19%), and lymphoma (8%)...
2015: Pediatric Hematology and Oncology
Verónica De la Maza, Daniela Simian, Magdalena Castro, Juan Pablo Torres, Yudeth Lucero, Fanny Sepúlveda, Soraya Mazquiaran, Carolina Salazar, Lorena Segovia, Maria Elena Santolaya
BACKGROUND: Early administration of antimicrobial (AM) is relevant in children with cancer, fever and neutropenia (FN). The recommendation is to administer the first dose of AM within the first hour of hospital admission. Our aims were to determine the time from the moment that a child with FN is admitted to the hospital until they receive their first dose of AM and to determine the association with clinical outcomes. METHODS: This prospective, multicenter study evaluated the time elapsed from the admission to the first dose of AM, comparing this variable by admitting hospital and presentation location (Emergency Department/Oncology Units) and evaluating the clinical outcomes by the following variables: days of fever, days of hospitalization, hypotension, transfer to intensive care unit, sepsis and mortality...
October 2015: Pediatric Infectious Disease Journal
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
Jesús Reyna-Figueroa, Alfredo Lagunas-Martínez, Pilar Martínez Matsumoto, Vicente Madrid-Marina
Among cancer and septic patients, there is a deregulation of common events such as inflammation. This fact limits the use of biomarkers to diagnose sepsis. Through a search in the PubMed database, we identified the clinical studies that evaluated procalcitonin as a biomarker among children with cancer and sepsis; we analyzed its characteristics, advantages and disadvantages. Most of the studies suggest that with a cut-off point between 0.5 ng/dl and 1 mg/dl, procalcitonin displays a sensitivity of 59-78%, a specificity of 76%, a predictive value of 93% and a negative predictive value of 45% to diagnose sepsis...
January 2015: Archivos Argentinos de Pediatría
A Vedi, V Pennington, M O'Meara, K Stark, A Senner, P Hunstead, K Adnum, W Londall, L Maurice, Claire Wakefield, R J Cohn
PURPOSE: Febrile neutropenia remains a common, life-threatening complication of chemotherapy in paediatric oncology. Delays in institution of empiric antibiotics have been identified at tertiary and regional centres caring for these patients and associated with decreased survival. Our objective was to reduce the time to administration of empiric antibiotics to less than 60 min from the time of presentation to hospital. METHODS: A retrospective study of the records of oncology patients presenting to the emergency department of a tertiary hospital over a 3-month period was performed and time to first antibiotic administration recorded...
July 2015: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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