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Fever in neutropenia in children and adolescents: Evolution over time of main characteristics in a single center, 1993-2001

Ammann, Roland ; Aebi, Christoph ; Hirt, Andreas ; Ridolfi Lüthy, Annette

In: Supportive Care in Cancer, 2004, vol. 12, no. 12, p. 826-832

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    Titre
    • Fever in neutropenia in children and adolescents: Evolution over time of main characteristics in a single center, 1993-2001
    Auteur
    • Ammann, Roland. Division of Pediatric Hematology and Oncology, University Children's Hospital, University of Bern, Bern, Switzerland
    • Aebi, Christoph. Division of Pediatric Hematology and Oncology, University Children's Hospital, University of Bern, Bern, Switzerland
    • Hirt, Andreas. Division of Pediatric Hematology and Oncology, University Children's Hospital, University of Bern, Bern, Switzerland
    • Ridolfi Lüthy, Annette. Division of Pediatric Hematology and Oncology, University Children's Hospital, University of Bern, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Supportive Care in Cancer, 2004, vol. 12, no. 12, p. 826-832. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:314078
    Summary
    Goals of work: To assess the evolution over time of main characteristics of episodes of fever in severe chemotherapy-induced neutropenia (FN) in children and adolescents with cancer treated for FN following nonmyeloablative chemotherapy, to compare the results with the experiences of other centers, and to assess the impact of the changes found on management of FN and on risk prediction rules. Patients and methods: Retrospective cohort study of all children and adolescents up to 18 years presenting with FN in a single pediatric oncology unit between 1993 and 2001. Main results: In 132 patients, 364 episodes of FN were reported. The relative incidence of FN increased significantly over time in patients with precursor B-cell acute lymphoblastic leukemia (PBC-ALL), reflecting the increased intensity of chemotherapy. At presentation with FN, the proportions of patients (1) with PBC-ALL versus other malignancies, (2) with other malignancies being in complete remission, (3) with a central venous catheter, and (4) with shaking chills all significantly increased over time (overall proportions, 64%, 60%, 50%, and 5%, respectively; p <0.001 for all). In 337 (93%) episodes, ceftriaxone plus amikacin was used as empirical broad spectrum antimicrobial therapy. Conclusions: This study demonstrates that some characteristics of FN, though not necessarily its management, change over time, implying regular update of risk prediction rules. In contrast to other centers, the first-line antimicrobial therapy did not need modification because of changing resistance patterns