Duncan C, Chisholm J C, Freeman S, Riley U, Sharland M, Pritchard-Jones K
Children's Unit, Royal Marsden Hospital, Sutton, United Kingdom.
Pediatr Blood Cancer. 2007 Oct 15;49(5):678-81. doi: 10.1002/pbc.21041.
The Paediatric Oncology Centres (POCs) treating childhood cancer in South East England produce unified supportive care guidelines for use in the secondary pediatric (shared care) units. This study evaluated the adherence to current guidelines for febrile neutropenia (FN) and documented outcome in terms of bacterial isolates, antibiotic resistance patterns, length of hospital stay, and mortality.
Prospective study of pediatric FN admissions between July 2001 and December 2002.
Data were received on 433 eligible FN episodes in 212 patients. The recommended empirical antibiotics (piptazobactam + gentamicin) were used in 354 (82%) admissions. Blood cultures were positive in 129 episodes (30%). Gram-positive organisms predominated (120/149 organisms isolated) and the majority were coagulase-negative Staphylococci (95/120). There were 27 Gram-negative isolates and 1 fungal isolate. No Gram-negative isolate was resistant to both first-line antibiotics. Only one death was recorded in the study group. The median length of hospital stay was 5 days.
We obtained data on a large number of shared care episodes of FN. The antibiotic guidelines were followed in most episodes. Bacteremia was common, but little resistance to first-line antibiotics was documented among Gram-negative isolates, confirming the safety of the strategy in our population.
英格兰东南部治疗儿童癌症的儿科肿瘤中心制定了统一的支持性护理指南，供二级儿科（共享护理）病房使用。本研究评估了对当前发热性中性粒细胞减少症（FN）指南的遵循情况，并记录了细菌分离株、抗生素耐药模式、住院时间和死亡率等结果。
对2001年7月至2002年12月期间儿科FN住院病例进行前瞻性研究。
收到了212例患者433次符合条件的FN发作的数据。354例（82%）住院病例使用了推荐的经验性抗生素（哌拉西林他唑巴坦+庆大霉素）。129次发作（30%）血培养呈阳性。革兰氏阳性菌占主导（分离出149株细菌中的120株），大多数是凝固酶阴性葡萄球菌（120株中的95株）。有27株革兰氏阴性菌分离株和1株真菌分离株。没有革兰氏阴性菌分离株对两种一线抗生素都耐药。研究组仅记录到1例死亡。住院时间中位数为5天。
我们获得了大量FN共享护理发作的数据。大多数发作遵循了抗生素指南。菌血症很常见，但革兰氏阴性菌分离株中对一线抗生素耐药的情况很少，证实了该策略在我们人群中的安全性。
