Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee.
Pediatr Blood Cancer. 2018 Mar;65(3). doi: 10.1002/pbc.26875. Epub 2017 Nov 8.
Febrile neutropenia (F&N) is common among pediatric oncology patients. However, there is a lack of clarity regarding parameters whereby such patients have demonstrated adequate bone marrow recovery for hospital discharge and empiric antibiotic discontinuation.
A retrospective review was performed for 350 episodes of F&N occurring at a single institution between 2007 and 2012 in pediatric oncology patients who were afebrile for 24 hr and had no bacterial source identified. Seven-day postdischarge outcomes were assessed and compared based on absolute neutrophil count (ANC) at discharge in order to identify an optimal threshold.
Overall, 7-day readmission rates were low (17/350, 4.6%), with patients discharged with post-nadir ANC of 100-199/μl (2/51, 3.9%), 200-499/μl (5/125, 4.0%), and ≥500/μl (8/160, 5.0%), all having similar rates. Patients with a discharge ANC < 100/μl (2/14, 14.3%) had a higher readmission rate. A new bloodstream infection was identified upon readmission in one patient in each discharge ANC range except for ANC of 100-199/μl, in which none occurred. In a subset of 217 episodes where the ANC fell below 200/μl during the admission and subsequently rose above 100/μl, 94 episodes resulted in 126 additional hospital days while subjects awaited further count recovery. One death occurred in a patient whose ANC at discharge was 290/μl. This patient had received additional chemotherapy after count recovery and prior to discharge, and was readmitted with Clostridium tertium bacteremia.
These results suggest that a post-nadir ANC > 100/μl is a safe threshold value for empiric antibiotic discontinuation and discharge home.
发热性中性粒细胞减少症（F&N）在儿科肿瘤患者中很常见。然而，对于此类患者骨髓恢复足以出院和停用经验性抗生素的参数尚不清楚。
对 2007 年至 2012 年在单一机构发生的 350 例儿科肿瘤患者 F&N 发作进行回顾性分析，这些患者发热 24 小时后体温正常且未发现细菌来源。根据出院时的绝对中性粒细胞计数（ANC）评估并比较 7 天出院后结局，以确定最佳阈值。
总体而言，7 天再入院率较低（17/350，4.6%），出院时 ANC 后最低值为 100-199/μl（51 例中有 2 例，3.9%）、200-499/μl（125 例中有 5 例，4.0%）和≥500/μl（160 例中有 8 例，5.0%）的患者再入院率相似。ANC<100/μl（14 例中有 2 例，14.3%）的患者再入院率较高。除 ANC 为 100-199/μl 的患者外，每位出院 ANC 范围内的患者在再次入院时均发现新的血流感染。在 ANC 降至 200/μl 以下且随后升至 100/μl 以上的 217 例亚组中，94 例导致 126 例患者需额外住院治疗，等待进一步计数恢复。一名 ANC 出院时为 290/μl 的患者死亡。该患者在计数恢复后并在出院前接受了额外的化疗，并因梭状芽孢杆菌感染入院。
这些结果表明，ANC 后最低值>100/μl 是停用经验性抗生素和出院回家的安全阈值。
