Department of Haematology & Oncology, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, United Kingdom.
Department of Haematology & Oncology, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom.
J Infect. 2015 Jun;71 Suppl 1:S27-35. doi: 10.1016/j.jinf.2015.04.026. Epub 2015 Apr 25.
Febrile neutropenia (FN) in children treated for malignancy is a common and direct sequela of chemotherapy. Episodes of FN can be life-threatening, and demand prompt recognition, assessment and treatment with broad spectrum antibiotics. While in the majority of episodes no causal infection is identified, 10-20% are secondary to a bloodstream infection (BSI). A reduction in episodes of BSI could be achieved through robust infection prevention strategies, such as CVL care bundles. Alongside good antimicrobial stewardship, these strategies could reduce the risk of emergent, multi-drug resistant (MDR) infections. Emerging bacterial pathogens in BSI include Viridans Group Streptococci (VGS) and Enterobacteriaceae such as Klebsiella spp. which are known for their ability to carry MDR genes. There is also increased recognition of the role of invasive fungal infection (IFI) in FN, in particular with Aspergillus spp. Novel diagnostics, including multiplex blood and respiratory polymerase chain reaction assays can identify infections early in FN, facilitating targeted therapy, and reducing unnecessary antimicrobial exposure. Given appropriate, and sensitive rapid diagnostics, potential also exists to safely inform the risk assessment of patients with FN, identifying those at low risk of complication, who could be treated in the out-patient setting. Several clinical decision rules (CDR) have now been developed and validated in defined populations, for the risk assessment of children being treated for cancer. Future research is needed to develop a universal CDR to improve the management of children with FN.
儿童恶性肿瘤化疗后出现发热性中性粒细胞减少症（FN）是一种常见的直接化疗后遗症。FN 发作可能危及生命，需要及时识别、评估和使用广谱抗生素进行治疗。虽然大多数发作没有明确的感染原因，但 10-20%的发作是血流感染（BSI）的继发原因。通过强化感染预防策略，如中央静脉置管（CVL）护理包，可以减少 BSI 发作次数。与良好的抗菌药物管理策略相结合，这些策略可以降低紧急、多重耐药（MDR）感染的风险。BSI 中出现的新兴细菌病原体包括草绿色链球菌（VGS）和肠杆菌科细菌，如肺炎克雷伯菌等，它们以携带 MDR 基因的能力而闻名。侵袭性真菌感染（IFI）在 FN 中的作用也越来越受到重视，特别是曲霉菌属。新型诊断方法，包括多重血液和呼吸道聚合酶链反应检测，可在 FN 早期识别感染，促进靶向治疗，减少不必要的抗菌药物暴露。如果有适当和敏感的快速诊断方法，也有可能安全地告知 FN 患者的风险评估，识别出那些并发症风险低的患者，可以在门诊环境中进行治疗。目前已经在特定人群中开发和验证了几种临床决策规则（CDR），用于评估癌症治疗儿童的风险。需要进一步的研究来开发通用的 CDR，以改善 FN 患儿的管理。
