Sugiura Shiro, Ito Tsuyoshi, Koyama Norihisa, Sasaki Noriko, Ikai Hiroshi, Imanaka Yuichi
Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan.
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Pediatr Int. 2017 Jan;59(1):23-28. doi: 10.1111/ped.13077. Epub 2016 Sep 21.
Febrile neutropenia (FN) can be a life-threatening complication in children with malignancies. There is no standardized preventive treatment for childhood FN, and information on C-reactive protein (CRP) elevation in afebrile patients with neutropenia (CEAN) is limited. The aim of this study was therefore to identify the association between CEAN and FN onset, and evaluate the efficacy of broad-spectrum antibiotics for FN prophylaxis.
We retrospectively reviewed the medical records of 22 consecutive pediatric patients with hematologic malignancies (acute myeloid leukemia, n = 2; acute lymphoid leukemia, n = 20) admitted to the present institution between 2006 and 2011. CEAN was defined as CRP elevation ≥0.05 mg/dL between the two most recent blood tests with no fever. We identified CEAN before FN onset, and assessed the efficacy of broad-spectrum antibiotics for FN prevention in CEAN. FN incidence within 48 h after CEAN detection was compared between prophylactic and non-prophylactic episodes.
CEAN was observed before FN onset in 20 (55.6%), of 36 FN episodes. Among the 95 analyzed CEAN episodes, broad-spectrum antibiotics had been used for 30 episodes (prophylactic episodes), whereas these antibiotics had not been used in 60 episodes (non-prophylactic episodes). Prophylactic episodes had a significantly lower FN incidence than non-prophylactic episodes (6.7% and 31%, respectively, P < 0.01) within 48 h after CEAN detection. Bacteremia was observed in three non-prophylactic episodes.
Patients with CEAN are at higher risk of FN, and physicians may consider the use of broad-spectrum antibiotics to prevent FN development.
发热性中性粒细胞减少症（FN）可能是恶性肿瘤患儿危及生命的并发症。儿童FN尚无标准化的预防性治疗方法，关于无发热的中性粒细胞减少症患者C反应蛋白（CRP）升高（CEAN）的信息有限。因此，本研究旨在确定CEAN与FN发作之间的关联，并评估广谱抗生素预防FN的疗效。
我们回顾性分析了2006年至2011年间连续收治于本机构的22例血液系统恶性肿瘤儿科患者（急性髓系白血病，n = 2；急性淋巴细胞白血病，n = 20）的病历。CEAN定义为最近两次无发热的血液检查之间CRP升高≥0.05mg/dL。我们在FN发作前确定CEAN，并评估广谱抗生素预防CEAN中FN的疗效。比较预防性和非预防性发作中CEAN检测后48小时内的FN发生率。
在36次FN发作中，20次（55.6%）在FN发作前观察到CEAN。在95次分析的CEAN发作中，30次发作（预防性发作）使用了广谱抗生素，而60次发作（非预防性发作）未使用这些抗生素。预防性发作在CEAN检测后48小时内的FN发生率明显低于非预防性发作（分别为6.7%和31%，P < 0.01）。在3次非预防性发作中观察到菌血症。
CEAN患者发生FN的风险较高，医生可考虑使用广谱抗生素预防FN的发生。
