Çocukluk Çağı Akut Lösemilerinde Febril Nötropeni: Klinik ve Mikrobiyolojik Değerlendirme

Abstract

Amaç: Bu çalışmada, akut lösemi tanılı pediatrik hastalarda kemoterapi ile ilişkili febril nötropeni (FN) ataklarında bakteriyemi sıklığının ve etken mikroorganizmaların belirlenmesi; bakteriyemi ve tedavi sonuçlarıyla ilişkili klinik özelliklerin değerlendirilmesi amaçlandı. Yöntemler: Pediatrik Hematoloji-Onkoloji Kliniği’nde 1 Ocak 2008–31 Aralık 2011 tarihleri arasında akut lösemi tanısıyla takip edilen çocuklarda gelişen FN atakları retrospektif olarak analiz edildi. Klinik ve mikrobiyolojik bulgular, tedavi yönetimi ve mortalite sonuçları değerlendirildi. Bulgular: Tedavi ve takip süresince akut lösemi tanılı 50 çocukta gelişen toplam 260 FN atağı analiz edildi. Atakların %59,6’sında klinik ve/veya mikrobiyolojik olarak kanıtlanmış enfeksiyon saptandı. Bakteriyemi oranı %19,2 idi. İzole edilen etkenlerin %52’si Gram-pozitif bakteriler, %24’ü Gram-negatif bakteriler ve %14’ü fungal patojenlerdi. Başlangıç ampirik tedavisinde başarı oranı %56,5 olup atakların %41,2’sinde tedavi modifikasyonu gerekti. Derin nötropeni, yani mutlak nötrofil sayısının <100/mm³ olması, tedavi başarısızlığı ile anlamlı şekilde ilişkili bulundu (p≤0,001). Mortalite oranı %12 olarak saptandı. Sonuç: Febril nötropeni, akut lösemili çocuklarda önemli bir morbidite ve mortalite nedenidir. Lokal etken dağılımının ve klinik risk özelliklerinin bilinmesi, ampirik antimikrobiyal tedavinin yönlendirilmesi açısından önemlidir. Derin nötropeni tedavi başarısızlığı ile ilişkili bulunmuştur ve klinik risk değerlendirmesinde dikkate alınmalıdır.

Keywords

• Akut lösemi
• bakteriyemi
• febril nötropeni
• pediatri
• risk sınıflaması

Ethical Statement

Çalışma, yerel Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından 13 Ocak 2012 tarihinde, 368 sayılı karar ile onaylandı. Çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütüldü. Retrospektif tasarımı nedeniyle bireysel bilgilendirilmiş onam gerekliliği etik kurul tarafından kaldırıldı.

Febrile Neutropenia in Childhood Acute Leukemia: A Clinical and Microbiological Evaluation

Abstract

Objective: This study aimed to determine the frequency of bacteremia and causative microorganisms in chemotherapy-associated febrile neutropenia (FN) episodes in pediatric patients with acute leukemia and to evaluate clinical characteristics associated with bacteremia and treatment outcomes. Methods: Febrile neutropenia episodes occurring in children with acute leukemia who were followed in the Pediatric Hematology-Oncology Clinic between January 1, 2008, and December 31, 2011, were retrospectively analyzed. Clinical and microbiological findings, antimicrobial treatment, and mortality outcomes were evaluated. Results: A total of 260 FN episodes in 50 children with acute leukemia were analyzed. Clinically and/or microbiologically documented infection was detected in 59.6% of episodes, and the bacteremia rate was 19.2%. Of the isolated pathogens, 52% were Gram-positive bacteria, 24% were Gram-negative bacteria, and 14% were fungi. Initial empirical therapy was successful in 56.5% of episodes, whereas treatment modification was required in 41.2%. Profound neutropenia, defined as an absolute neutrophil count <100/mm³, was significantly associated with treatment failure (p≤0.001). Patient-level mortality was 12%. Conclusion: Febrile neutropenia remains an important cause of morbidity and mortality in children with acute leukemia. Knowledge of local pathogen distribution and relevant clinical risk characteristics may help guide empirical antimicrobial therapy. Profound neutropenia was associated with treatment failure and should be considered during clinical risk assessment.

Keywords

• Acute leukemia
• bacteremia
• febrile neutropenia
• pediatrics
• risk stratification

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