Akut Lösemili Çocuklarda Febril Nötropeni Ataklarının Değerlendirilmesi

Year 2012, Volume: 6 Issue: 2, 93 - 100, 01.08.2012

Esma Altınel Neşe Yaralı Pamir Işık Serdar Özkasap Ali Bay Abdurrahman Kara Bahattin Tunç

Abstract

Bu çalışmada 75 lösemili çocukta gelişen 221 febril nötropeni (FN) atağı retrospektif olarak incelenerek ampirik antibiyoterapi özellikleri, antibiyotik modifikasyonları, kültür sonuçları, tedavi süreleri ve mortaliteleri değerlendirildi. Mikrobiyolojik ve/veya klinik olarak kanıtlanmış enfeksiyon, 117 (%52.9) atakta saptandı. Kan kültüründe mikroorganizma izole edilme oranı %14.4 idi. Bunlardan %73.5’u gram pozitif, %17.6’sı gram negatif ve %8.8’i de fungal patojenlerdi. Ateşin kontrol altına alınma süresi ortalama 7.2 gün ve antibiyotik kullanma süresi ortalama 13 gün idi. Hastalarımızda, granülosit-koloni stimüle edici faktör (G-CSF) 102 FN atağında (%46.2) kullanıldı. Febril nötropeni atağı sırasında sekiz hasta (%3.6) kaybedildi.

Keywords

Febril nötropeni, çocuk, akut lösemi

EVALUATION OF FEBRILE NEUTROPENIA IN CHILDREN WITH ACUTE LEUKEMIA

Abstract

In this retrospective study, we evaluated 221 febrile neutropenia (FN) episodes in 75 pediatric leukemia cases during empiric antibiotherapy in terms of antibiotic modifications, culture results, treatment period and mortality retrospectively. One hundred and seventeen (52.9%) episodes were microbiologically and/or clinically documented infections. During febrile neutropenia attacks, 14.4% of patients had bacteriemia. Of isolated microorganisms, 73.5% gram-positive, 17.6% were gram-negative and 8.8% fungal pathogens. Fever resolved after mean 7.2 days and mean antibiotic administration time was 13 days. Granulocyte-colony stimulating factor (G-CSF) was used in 102 episodes (46.2%) of FN. Eight patients (%3.6) died during a FN episode

Keywords

Febrile neutropenia, children, acute leukemia

References

• Paul M, Yahav D, Fraser A, Leibovici L. Empirical antibiotic mo- notherapy for febrile neutropenia:systematic review and meta- analysis of randomized controlled trials. J Antimicrob Chemoter 2006;57(2):176-89.
• Laoprasopwattana K, Pruekprasert P, Laosombat V, Wongchanc- hailert M. Cinical outcome of febrile neutropenia in children with cancer using ceftazidime and aminoglycosides. Pediatr Hematol Oncol 2007;24:595-606.
• Akova M, Paesmans M, Calandra T, Viscoli C. A European Orga- nization for Research and Treatment of Cancer International Anti- microbial Therapy Group Study of Secondary infections in febrile neutropenic patients with cancer. Clin Infect Dis 2005;40(2):239-45.
• Sipsas NV, Bodey GP, Kontoyiannis DP. Perspectives for the ma- nagement of febrile neutropenic patients with cancer in the 21st century. Cancer 2005;103(6):1103-13.
• Hughes WT, Armstrong D, Bodey GP, Brow EJ, Brown AE, Ca- landra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenia patients with cancer. Clin Infect Dis 2002;34(6):730-51
• Giamarellou H, Antoniadou A. Infectious complications of febrile leukopenia. Infect Dis Clin North Am 2001;15(2):457-82.
• Çelebi S. Çocuklarda Febril Nötropeni. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2003;29(2):35-41.
• Hann L, Viscoli C, Paesmans M, Goya H, Glauser M and IATCG of EORTC. A comparison of outcome from febrile neutropenic epi- sodes in children compared with adults:results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treat- ment of Cancer (EORTC). Br J Haematol 1997;99(3):580-8.
• Santolaya ME, Alvarez AM, Avilés CL, Becker A, Cofré J, Enríquez N, et al. Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fe- ver and neutropenia. Clin Infect Dis 2002;35(6):678-83.
• Caillot D, Casasnovas O, Bernard A, Couaillier JF, Durand C, Cu- isenier B, et al. Improved management of invasive pulmonary as- pergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol 1997;15(1):139-47.
• Saugier-Veber P, Devergic A, Sulahian A, Ribaud P, Trao- re F, Bourdeau-Esperou H, et al. Epidemiology and diagnosis of invasive pulmonary aspergillosis in bone marrow transplant patients:result of a 5-year retrospective study. Bone Marrow Trans- plant 1993;12(2):121-4.
• Weber C, Maas R, Steiner P, Kramer J, Bumann D, Zander AR,et al. Importance of digital thoracic radiography in the diagnosis of pulmonary infiltrates in patients with bone marrow transplantation during aplasia. Rofo 1999;171(4):294-301.
• Baron O, Guillaume B, Morcau P, Germaud P, Despins P, De La- jartre AY, et al. Aggressive surgical management in localized pul- monary mycotic and nonmycotic infections for neutropenic pati- ents with acute leukemia:report of eighteen cases. J Thorac Cardi- ovasc Surg 1998;115(1):63-9.
• Reichenberger F, Habicht J, Kaim A, Dalquen P, Bernet F, Schläpfer R, et al. Lung resection for invasive pulmonary aspergillosis in ne- utropenic patients with hematologic diseases. Am J Resp Crit Care Med 1998;158(3):885-90.
• Demirkazık FB, Akın A, Uzun Ö, Akpınar MG, Arıyürek MO. CT findings in immuncompromised patients with pulmonary infecti- ons. Diagn Interv Radiol 2008;14(2):75-82.
• Yamamura D, Gucalp R, Carlisle P, Cimino M, Roberts J, Rots- tein C. Open randomized study of cefepime versus piperacillin- gentamicin for treatment of febrile neutropenic cancer patients. Antimicrob Agents Chemother 1997;41(8):1704-8.
• Cometta A, Calandra T, Gaya H, Zinner SH, de Bock R, Del Fave- ro A, et al. Monotherapy with meropenem versus combination the- rapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. The International Antimic- robial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer and the Gruppo Italiano Ma- lattie Ematologiche Maligne dell’Adulto Infection Program.Anti- microb Agents Chemother 1996;40(5):1108-15.
• Del Favero A, Menichetti F, Martino P, Bucaneve G, Micozzi A, Gentile G, et al. A multicenter, double-blind, placebo-controlled trial comparing piperacillin/tazobactam with and without ami- kacin as empiric therapy for febrile neutropenia. Clin Infect Dis 2001;33(8):1295-301.
• Çorapçıoğlu F, Sarıalioğlu F, Olgun N, Uysal KM. Analysis of 136 febrile neutropenic episodes in children with cancer:evaluation of treatment effectiveness and cost. Pediatr Hematol Oncol 2004;21(6):535-43.
• Lucas KG, Brown AE, Armstrong D, Chapman D, Heler G. The identification of febrile, neutropenic children with neoplastic dise- ase at low risk for bacteremia and complications of sepsis. Cancer 1996;77(4):791-8.
• Chamberlain JD, Smibert E, Skeen J, Alvaro F. Prospective audit of treatment of paediatric febrile neutropenia in Australasia. J Pae- diatr Child Health 2005;41(11):598-603.
• Elting LS, Rubenstein EB, Rolston K, Cantor SB, Martin CG, Kur- tin D, et al. Time to clinical response; an outcome of antibiotic the- rapy of febrile neutropenia with implications for quality and cost of care. J Clin Oncol 2000;18(21):3699-706.
• Ozer H, Armitage JO, Bennett CL, Crawford J, Demetri GD, Piz- zo PA, et al. Update of recommendations for the use of hematopo- ietic colony-stimulating factors: Evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Fac- tors Expert Panel. J Clin Oncol 2000;18(20):3558-85.
• Kebudi R, Devecioğlu Ö, Gürler N ve ark. Pediatrik febril nötrope- ni kılavuzu. Flora 2004;9(2):73-105.
• Hodgson-Viden H, Grundy PE, Robinson JL. Early discontinuati- on of intravenous antimicrobial therapy in pediatric oncology pati- ents with febrile neutropenia. BMC Pediatrics 2005;5(1):10.
• Basu SK, Fernandez ID, Fisher SG, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Clin Oncol 2005;23(31):7958-66.